Provider Demographics
NPI:1881935435
Name:SEEKURI MANOJ, DEEPTHI (MD)
Entity type:Individual
Prefix:
First Name:DEEPTHI
Middle Name:
Last Name:SEEKURI MANOJ
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 1:1900 E LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3824
Mailing Address - Country:US
Mailing Address - Phone:217-423-2889
Mailing Address - Fax:
Practice Address - Street 1:1900 E LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3824
Practice Address - Country:US
Practice Address - Phone:217-423-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
284300000X
IL036138351208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No284300000XHospitalsSpecial Hospital