Basavanthappa, Sreenivasa

Basavanthappa, Sreenivasa is an individual health care provider with primary practice located at 2501 E College Ave Ste B , Bloomington IL 61704-2484. He recently has only one registered license in Allopathic & Osteopathic Physicians / Retina Specialist, which is considered as his primary health care specialty. Basavanthappa, Sreenivasa can be contacted via phone (309) 557-8666.

Contact Information

Primary practice address
2501 E College Ave Ste B Bloomington IL 61704-2484
Phone: (309) 557-8666
Fax: (309) 827-8027
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Retina Specialist 207WX0107X 03-6163408 Illinois

Profile Details

NPI number 1497953871
LBN Legal business name Basavanthappa, Sreenivasa
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2007
Last updated Dec 28th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497953871 NPPES
Massachusetts MEDICAID 110096239A

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