Provider Demographics
NPI:1932208642
Name:SRIPADA, BHASKAR (MD)
Entity Type:Individual
Prefix:
First Name:BHASKAR
Middle Name:
Last Name:SRIPADA
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 1:10650 S LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2617
Mailing Address - Country:US
Mailing Address - Phone:847-946-8557
Mailing Address - Fax:773-881-1164
Practice Address - Street 1:10650 S LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2617
Practice Address - Country:US
Practice Address - Phone:847-946-8557
Practice Address - Fax:773-881-1164
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360522122084P0804X
IL036-0522122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry