Individual
MRS. GURRAMKONDA NAIDU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
120 NE GLEN OAK AVE, SUITE 306, PEORIA, IL 61603-4314
(309) 672-4582
(309) 672-4552
Mailing address
5000 RELIABLE PKWY, CHICAGO, IL 60682-0001
(309) 672-4582
(309) 672-4552
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036058664
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001011
HEALTH ALLIANCE
IL
01
—
0116
BLUE CROSS/BLUE SHIELD
IL
01
—
115958
HEALTHLINK
IL
05
—
370661223001
—
IL
05
—
370661223401
—
IL
01
—
A61636
JOHN DEERE
IL
Enumeration date
07/22/2006
Last updated
07/08/2007
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