Provider Demographics
NPI:1295793529
Name:KANNAN, SREEPATHY (MD)
Entity type:Individual
Prefix:DR
First Name:SREEPATHY
Middle Name:
Last Name:KANNAN
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 1:8S323 HAMPTON CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9322
Mailing Address - Country:US
Mailing Address - Phone:708-675-7110
Mailing Address - Fax:708-310-3430
Practice Address - Street 1:18327 DISTINCTIVE DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9461
Practice Address - Country:US
Practice Address - Phone:708-675-7110
Practice Address - Fax:708-310-3430
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1158472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology