Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01064406A | IN |
N | 111NI0900X | Internist | 01064406A | IN |
Y | 207R00000X | Internist | 036084786 | IL |
Y | 111NI0900X | Internist | 036084786 | IL |
N | 207R00000X | Internist | 32848 | WI |
N | 111NI0900X | Internist | 32848 | WI |
N | 207RA0401X | Internist - Addiction Medicine | 01064406A | IN |
N | 207RA0401X | Internist - Addiction Medicine | 036084786 | IL |
N | 207RA0401X | Internist - Addiction Medicine | 32848 | WI |
NPI | 1568531564 |
---|---|
Provider Name | Srinivas-Prasad Reddy Jolepalem |
First Address | Darien, IL 60561-8468 |
Second Address | Darien, IL 60561-8468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 22/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F46755 | (02) | |
IL8846 | MEDICARE PTAN# (01) | IL |
IL8846001 | MEDICARE PTAN# (01) | IL |