Provider Demographics
NPI:1669590329
Name:MAGULURI, SRILAKSHMI
Entity type:Individual
Prefix:DR
First Name:SRILAKSHMI
Middle Name:
Last Name:MAGULURI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SRI
Other - Middle Name:
Other - Last Name:MAGULURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10616
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-0616
Mailing Address - Country:US
Mailing Address - Phone:504-813-4218
Mailing Address - Fax:
Practice Address - Street 1:850 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3099
Practice Address - Country:US
Practice Address - Phone:504-813-4218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241473207W00000X
IL036118718207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.118718Medicaid
IL036.118718Medicaid