Individual
SUPARNA BASU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
228 NE JEFFERSON AVE, PEORIA, IL 61603-3802
(309) 671-8005
Mailing address
150 SAXON WOODS RD, SCARSDALE, NY 10583-7804
(516) 232-5732
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036.147481
IL
Other
Enumeration date
12/21/2008
Last updated
12/23/2020
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