Provider Demographics
NPI:1730493891
Name:SODANAPALLI, SREEDEVI (MD)
Entity Type:Individual
Prefix:DR
First Name:SREEDEVI
Middle Name:
Last Name:SODANAPALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SREEDEVI
Other - Middle Name:
Other - Last Name:SODANAPALLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8321 W GOLF RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1113
Mailing Address - Country:US
Mailing Address - Phone:847-720-3504
Mailing Address - Fax:224-251-7476
Practice Address - Street 1:8321 W GOLF RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1113
Practice Address - Country:US
Practice Address - Phone:847-720-3504
Practice Address - Fax:224-251-7476
Is Sole Proprietor?:No
Enumeration Date:2010-08-01
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.132499207R00000X
IL036132499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036132499Medicaid