Provider Demographics
NPI:1750434361
Name:DRS. SRIVASTAVA S.C.
Entity type:Organization
Organization Name:DRS. SRIVASTAVA S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-226-1906
Mailing Address - Street 1:5668 E STATE ST
Mailing Address - Street 2:SUITE 2700
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2490
Mailing Address - Country:US
Mailing Address - Phone:815-226-1906
Mailing Address - Fax:
Practice Address - Street 1:5668 E STATE ST
Practice Address - Street 2:SUITE 2700
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2490
Practice Address - Country:US
Practice Address - Phone:815-226-1906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL360611062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL008839OtherHEALTH ALLIANCE
IL0010100569OtherBCBS
IL008839OtherHEALTH ALLIANCE
IL657950Medicare ID - Type Unspecified