Provider Demographics
NPI:1285421115
Name:PREMIER INDEPENDENCE
Entity type:Organization
Organization Name:PREMIER INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRIDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATHIKANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-960-0293
Mailing Address - Street 1:340 LORTON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4126
Mailing Address - Country:US
Mailing Address - Phone:773-960-0293
Mailing Address - Fax:
Practice Address - Street 1:340 LORTON AVE STE 210
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4126
Practice Address - Country:US
Practice Address - Phone:773-960-0293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty