Srivastava, Madhav K

Srivastava, Madhav K is an sole proprietor health care provider with primary practice located at 4920 E State St , Rockford IL 61108-2272. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Srivastava, Madhav K can be contacted via phone (815) 226-1906.

Contact Information

Primary practice address
4920 E State St Rockford IL 61108-2272
Phone: (815) 226-1906
Fax: (815) 226-8474
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 36061106 Illinois

Profile Details

NPI number 1770565905
LBN Legal business name Srivastava, Madhav K
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 15th, 2005
Last updated Sep 26th, 2011 - about 15 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 1770565905 NPPES
Illinois Other 791133506 RETIRED RAILROAD
Illinois MEDICAID 036061106 RETIRED RAILROAD
Illinois Other 008839 RETIRED RAILROAD
Illinois Other 0010100569 RETIRED RAILROAD

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