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Organization
VSR PLLC
Active
Organization
VSR PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VENU M RANGU MD (PRESIDENT)
(715) 387-9055
Entity
Organization
Contact information
Practice address
180 W IMBODEN DR, DECATUR, IL 62521-5238
(715) 207-1134
Mailing address
4200 CONESTOGA DR STE 102, PO BOX 178, SPRINGFIELD, IL 62711-7937
(715) 207-1134
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F100973628
MEDICARE PTAN
IL
Enumeration date
06/07/2023
Last updated
06/20/2023
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