Organization
DEKALB MEDICAL CLINIC,INC
Active
Organization
DEKALB MEDICAL CLINIC,INC
Active
Other names
Dekalb Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VASANTHA L GONA M.D., (STAFF PHYSICIAN)
(352) 857-9150
Entity
Organization
Contact information
Practice address
2128 MIDLANDS CT, SUITE 106, SYCAMORE, IL 60178-3199
(815) 756-1434
Mailing address
2128 MIDLANDS CT, SUITE 106, SYCAMORE, IL 60178-3199
(815) 756-1434
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-099204
IL
Other
Enumeration date
04/14/2008
Last updated
01/25/2012
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