Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. SREENIVASA BASAVANTHAPPA, MD
ActiveDR. SREENIVASA BASAVANTHAPPA, MD is a Sports Medicine (Emergency) healthcare provider located in BLOOMINGTON, Illinois. NPI 1497953871 is currently active in the NPPES registry. Verify at CMS.
Sports Medicine (Emergency) · BLOOMINGTON, IL
Registration Details
- NPI Number
- 1497953871
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 6, 2007 (19.145315028409 yrs)
- Last Updated
- Dec 28, 2023
- License
-
03-6163408 (IL)
Practice Information
- Address
-
2501 E COLLEGE AVE STE BBLOOMINGTON, IL, 617042484Browse IL providers · Browse ZIP 61704
- Phone
- 3095578666
- Fax
- 3098278027
- Primary Specialty
-
Sports Medicine (Emergency)
207WX0107X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.