Provider Demographics
NPI:1699852939
Name:SHREENIVAS, BINDIGANAVLE G (MD)
Entity Type:Individual
Prefix:
First Name:BINDIGANAVLE
Middle Name:G
Last Name:SHREENIVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHREENIVAS
Other - Middle Name:G
Other - Last Name:B
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:6084 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2747
Practice Address - Country:US
Practice Address - Phone:773-884-4152
Practice Address - Fax:773-884-4167
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053085207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053085Medicaid
IL11024172OtherRAIL ROAD MEDICARE
IL21608591OtherBCBS PROVIDER ID
IL11024172Medicare PIN
IL200029Medicare PIN
IL11024172OtherRAIL ROAD MEDICARE