Provider Demographics
NPI:1679571236
Name:GUNDALA, SRISUDHA REDDY (MD)
Entity type:Individual
Prefix:
First Name:SRISUDHA
Middle Name:REDDY
Last Name:GUNDALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 KESLINGER RD STE 160
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3753
Mailing Address - Country:US
Mailing Address - Phone:630-232-7200
Mailing Address - Fax:630-232-2288
Practice Address - Street 1:2800 KESLINGER RD STE 160
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3753
Practice Address - Country:US
Practice Address - Phone:630-232-7200
Practice Address - Fax:630-232-2288
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099196208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099196Medicaid