Organization
MADHUPA SUD MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MADHUPA SUD M.D. (PRESIDENT)
(773) 995-3460
Entity
Organization
Contact information
Practice address
45 W 111TH ST, CHICAGO, IL 60628
(773) 995-3460
Mailing address
192 ASHTON DR, BURR RIDGE, IL 60527
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036063319
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036063319
—
IL
Enumeration date
11/18/2015
Last updated
11/18/2015
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