Individual
MRS. UDAYA BONTU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
300 RANDALL RD, GENEVA, IL 60134-4200
(630) 933-4700
(630) 933-4427
Mailing address
300 RANDALL RD, GENEVA, IL 60134-4200
(630) 933-4700
(630) 933-4427
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036091568
IL
208M00000X
Hospitalist Physician
Primary
036091568
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036091568
—
IL
01
—
04532170
BLUE CROSS BLUE SHIELD
IL
01
—
610033301
DOL WORKCOMP
IL
01
—
DB0387
RAILROAD MEDICARE GROUP
IL
01
—
P00083896
RAILROAD MEDICARE
IL
Enumeration date
07/11/2005
Last updated
04/23/2024
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