Organization
CHOUDARY V. KAVURI MD, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUNITHA KAVURI (OFFICE MANAGER)
(217) 428-1900
Entity
Organization
Contact information
Practice address
1770 E LAKE SHORE DR, SUITE 208, DECATUR, IL 62521-3832
(217) 428-1900
(217) 428-0358
Mailing address
1770 E LAKE SHORE DR STE 208, DECATUR, IL 62521-3839
(217) 428-1900
(217) 428-0358
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036072000
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036072000
—
IL
01
—
05821917
BCBS
IL
Enumeration date
10/28/2008
Last updated
09/13/2013
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