Provider Demographics
NPI:1316904816
Name:SASTRI, SURIYA (MD)
Entity type:Individual
Prefix:
First Name:SURIYA
Middle Name:
Last Name:SASTRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 S MADISON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8433
Mailing Address - Country:US
Mailing Address - Phone:630-325-8684
Mailing Address - Fax:630-325-2490
Practice Address - Street 1:6900 S MADISON ST STE 102
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-8433
Practice Address - Country:US
Practice Address - Phone:630-325-8684
Practice Address - Fax:630-325-2490
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036068118207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068118Medicaid
IL036068118Medicaid
ILL97405Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 15
ILL97404Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 16