Doctor Name: | MEDHA CHUNDURU |
NPI Number: | 1013395086 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 125-066467 |
Business Practice Address: | 1221 E State St Rockford, IL - 611042231 |
Business Phone Number: | 8159721000 |
Business Fax Number: | 8159721093 |
Mailing Address: | 1221 E State St, ROCKFORD |
State: | IL |
Postal Code: | 611042231 |
Phone Number: | 8159721000 |
Fax Number: | 8159721093 |
NPI Enumeration Date: | 05/11/2015 |
NPI Last Update Date: | 05/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 125-066467 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |