Provider Demographics
NPI:1972672830
Name:DR. ANEKAL B. SREERAM
Entity Type:Organization
Organization Name:DR. ANEKAL B. SREERAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANEKAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SREERAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-756-3988
Mailing Address - Street 1:7895 BROADWAY STE V
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5529
Mailing Address - Country:US
Mailing Address - Phone:219-756-3988
Mailing Address - Fax:219-756-2595
Practice Address - Street 1:255 E 90TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8103
Practice Address - Country:US
Practice Address - Phone:219-756-3988
Practice Address - Fax:219-756-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046404A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G15408Medicare UPIN
IN229370Medicare ID - Type Unspecified