Provider Demographics
NPI:1891169488
Name:GIRI, SNEHA
Entity Type:Individual
Prefix:
First Name:SNEHA
Middle Name:
Last Name:GIRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SNEHA
Other - Middle Name:
Other - Last Name:GOSWAMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST STE 15-200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5967
Mailing Address - Country:US
Mailing Address - Phone:312-695-8182
Mailing Address - Fax:
Practice Address - Street 1:675 N SAINT CLAIR ST STE 15-200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5967
Practice Address - Country:US
Practice Address - Phone:312-695-8182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2019-06-13
Deactivation Date:2019-03-19
Deactivation Code:
Reactivation Date:2019-03-27
Provider Licenses
StateLicense IDTaxonomies
IL125.073668207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology