Organization
MADHU GUNDAVARAM MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MADHU S GUNDAVARAM MD (PRESIDENT)
(773) 354-0210
Entity
Organization
Contact information
Practice address
326 W 64TH ST, CHICAGO, IL 60621-3114
(773) 962-3900
Mailing address
655 W HOBBIE ST, CHICAGO, IL 60610-2433
(773) 354-0210
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036112955
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112955
—
IL
Enumeration date
02/02/2010
Last updated
02/02/2010
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