Provider Demographics
NPI:1023124302
Name:DANVILLE PAIN & REHABILITATION MEDICINE CENTER, LLC
Entity type:Organization
Organization Name:DANVILLE PAIN & REHABILITATION MEDICINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNKAVALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-267-2175
Mailing Address - Street 1:733 N LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4378
Mailing Address - Country:US
Mailing Address - Phone:217-267-2175
Mailing Address - Fax:217-267-2179
Practice Address - Street 1:733 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4378
Practice Address - Country:US
Practice Address - Phone:217-267-2175
Practice Address - Fax:217-267-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI17284Medicare UPIN
IL209984Medicare PIN