Individual
VIDYA SUNDARESHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
751 N RUTLEDGE ST, SUITE 1100, SPRINGFIELD, IL 62702-4909
(217) 545-9537
(217) 545-8025
Mailing address
PO BOX 19636, SPRINGFIELD, IL 62794-9636
(217) 545-9537
(217) 545-8025
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-121672
IL
207RI0200X
Infectious Disease Physician
Primary
036-121672
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036121672
—
IL
Enumeration date
08/27/2008
Last updated
01/21/2010
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