Provider Demographics
NPI:1447351192
Name:SRIVASTAVA, RICHA (MD)
Entity type:Individual
Prefix:DR
First Name:RICHA
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59612
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60159-0612
Mailing Address - Country:US
Mailing Address - Phone:847-934-8135
Mailing Address - Fax:
Practice Address - Street 1:802 E WOODFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4712
Practice Address - Country:US
Practice Address - Phone:847-773-5080
Practice Address - Fax:847-348-3848
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107477Medicaid
IL210278OtherORG.MC PIN
IL036107477Medicaid
IL210278OtherORG.MC PIN