Provider Demographics
NPI:1942663497
Name:DENDULURI, MEENAKSHI SHIVARAM (MD)
Entity type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:SHIVARAM
Last Name:DENDULURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEENAKSHI
Other - Middle Name:RANJANI
Other - Last Name:SHIVARAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:25 E WASHINGTON ST STE 1805
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1829
Mailing Address - Country:US
Mailing Address - Phone:312-782-5959
Mailing Address - Fax:312-782-5960
Practice Address - Street 1:25 E WASHINGTON ST STE 1805
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1829
Practice Address - Country:US
Practice Address - Phone:312-782-5959
Practice Address - Fax:312-782-5960
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1643932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry