Individual
DR. MADHUSUDAN VALLALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 SAINT ANTHONYS WAY, SUITE 205, ALTON, IL 62002-4569
(618) 462-2222
(618) 463-5004
Mailing address
2 SAINT ANTHONYS WAY, SUITE 205, ALTON, IL 62002-4569
(618) 462-2222
(618) 463-5004
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036053208
IL
207RC0000X
Cardiovascular Disease Physician
036053208
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036053208
—
IL
Enumeration date
08/15/2006
Last updated
08/18/2015
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