Individual
MS. SUJATHA R GOGULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
431 W LIBERTY ST, WAUCONDA, IL 60084-2452
(847) 526-2151
(815) 678-4184
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003332
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085003332
STATE LICENSE FROM ILLINOIS
IL
Enumeration date
10/08/2008
Last updated
06/10/2024
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