Provider Demographics
NPI:1982672663
Name:SRIVASTAVA, ALKA (MBBS)
Entity Type:Individual
Prefix:DR
First Name:ALKA
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:DR
Other - First Name:ALKA
Other - Middle Name:
Other - Last Name:SHANKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:9 LAKE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5979
Mailing Address - Country:US
Mailing Address - Phone:708-848-8240
Mailing Address - Fax:708-383-2135
Practice Address - Street 1:6300 ROOSEVELT RD
Practice Address - Street 2:STE 2
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2303
Practice Address - Country:US
Practice Address - Phone:708-848-8240
Practice Address - Fax:708-383-2135
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF41329Medicare UPIN