Individual
DR. SURENDRA B AVULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4950 W 95TH ST, OAK LAWN, IL 60453-2504
(708) 576-8150
(708) 576-8831
Mailing address
4950 W 95TH ST, OAK LAWN, IL 60453-2504
(708) 576-8150
(708) 576-8831
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036-082117
IL
207RI0011X
Interventional Cardiology Physician
036082117
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036082117
—
IL
01
—
060053845
PALMETTO GBA INDIVIDUAL #
IL
01
—
21622931
BCBS GROUP #
IL
01
—
CI8250
PALMETTO GBA GROUP #
IL
Enumeration date
08/26/2005
Last updated
09/10/2024
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