Provider Demographics
NPI:1780639062
Name:SASIKUMAR, PREETHI (MD)
Entity Type:Individual
Prefix:DR
First Name:PREETHI
Middle Name:
Last Name:SASIKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SALT CREEK LN
Mailing Address - Street 2:SUITE 111
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2926
Mailing Address - Country:US
Mailing Address - Phone:630-371-0133
Mailing Address - Fax:630-371-0138
Practice Address - Street 1:15 SALT CREEK LN
Practice Address - Street 2:SUITE 111
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2926
Practice Address - Country:US
Practice Address - Phone:630-371-0133
Practice Address - Fax:630-371-0138
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113443Medicaid
ILK21360Medicare PIN
ILK21359Medicare PIN
ILI42734Medicare UPIN