Provider Demographics
NPI:1740284504
Name:VANKANA, SARITHA (MD)
Entity type:Individual
Prefix:DR
First Name:SARITHA
Middle Name:
Last Name:VANKANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6529 MIDDLECOFF CT
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1487
Mailing Address - Country:US
Mailing Address - Phone:630-886-3209
Mailing Address - Fax:708-330-4530
Practice Address - Street 1:1516 W MADISON
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-343-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2019-11-30
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
IL036-098715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098715Medicaid
IL645020Medicare ID - Type UnspecifiedPROVODER #