Provider Demographics
NPI:1255623997
Name:MAJJIGA, VENKATA SASIDHAR (MD)
Entity type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:SASIDHAR
Last Name:MAJJIGA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 19676
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9676
Mailing Address - Country:US
Mailing Address - Phone:800-331-2229
Mailing Address - Fax:217-757-6488
Practice Address - Street 1:301 N 8TH STREET, SIU SCHOOL OF MEDICINE, PEDIATRICS
Practice Address - Street 2:ROOM 3A169
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62794
Practice Address - Country:US
Practice Address - Phone:217-545-7732
Practice Address - Fax:217-757-6488
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.1273012080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036127301Medicaid