Individual provider · Type 1 NPI
Sreenivasa Basavanthappa, MD
Retina Specialist (Ophthalmology) Physician · Bloomington, IL
NPI number
1497953871
Active
Practice location
2501 E College Ave Ste B
Bloomington, IL 61704-2484
Fax (309) 827-8027
Mailing address
1008 N Main St
Bloomington, IL 61701-1784
Other practice locations
- 322 W Marion Ave, Forsyth, IL 62535-1064 · (217) 872-7404
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Retina Specialist (Ophthalmology) Physician Primary | 207WX0107X | 03-6163408 (IL) |
Retina Specialist (Ophthalmology) Physician: An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases.
About NPI 1497953871
Sreenivasa Basavanthappa, MD's National Provider Identifier is 1497953871, issued on Jul 6, 2007. The primary taxonomy on file is Retina Specialist (Ophthalmology) Physician (207WX0107X), and the practice location is in Bloomington, IL. The record was last updated on Dec 28, 2023.