Individual
SUGUNA SIRAMDASU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
812 N LOGAN AVE, DANVILLE, IL 61832-3752
(217) 443-5000
Mailing address
PO BOX 532904, ATLANTA, GA 30353-2904
(217) 443-5000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036061870
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36061870
—
IL
01
—
50091711
RR MEDICARE
IL
01
—
9232012
BCBS
IL
01
—
DA4244
RR MEDICARE GROUP
IL
Enumeration date
08/11/2006
Last updated
11/07/2008
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