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Dr. Sreenivasa Basavanthappa, MD
Retina Specialist (Ophthalmology) Physician in Bloomington, Illinois
NPI 1497953871

Sreenivasa Basavanthappa is a Retina Specialist (Ophthalmology) Physician based in Bloomington, IL and is specialized in Retina Specialist. Sreenivasa Basavanthappa practices in Bloomington, IL and has the professional credentials of MD. The NPI Number for Sreenivasa Basavanthappa is 1497953871 and holds a License No. 03-6163408 (Illinois).

The current practice location address for Sreenivasa Basavanthappa is 2501 E College Ave Ste B, Bloomington, IL and can be reached out via phone at 309-557-8666 and via fax at 309-827-8027.

Location: 2501 E College Ave Ste B, Bloomington, IL, 61701-1784
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1497953871
Provider Name
Sreenivasa Basavanthappa
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
2501 E College Ave Ste B, Bloomington, IL, 61701-1784
Phone Number
309-557-8666
Fax Number
309-827-8027
Provider Enumeration Date
07/06/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
110096239A 05 MA
institution
Provider Business Practice Location Address Details
Address
2501 E College Ave Ste B
City
Bloomington
State
Illinois
Zip
61704-2484
Phone Number
309-557-8666
Fax Number
309-827-8027
person
Provider Business Mailing Address Details
Address
2501 E College Ave Ste B
City
Bloomington
State
Illinois
Zip
61704-2484
Phone Number
309-557-8666
Fax Number
309-827-8027
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Ophthalmology
Speciality
Retina Specialist
Taxonomy
207WX0107X
License No.
03-6163408 (Illinois)
Definition
An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases.
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