Provider Demographics
NPI:1801849807
Name:TALLURI, SRIKRISHNA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIKRISHNA
Middle Name:M
Last Name:TALLURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 W HIGGINS RD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-2428
Mailing Address - Country:US
Mailing Address - Phone:630-323-0024
Mailing Address - Fax:
Practice Address - Street 1:2200 W HIGGINS RD
Practice Address - Street 2:SUITE 245
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60195-2428
Practice Address - Country:US
Practice Address - Phone:630-323-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21609461OtherBLUE CROSS BLUE SHIELD
ILD13500Medicare UPIN
IL21609461OtherBLUE CROSS BLUE SHIELD