MEDICARE: SUGUNA BABU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician		IL

General Provider Information

NPI Number	:	1164454914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUGUNA BABU M.D.

Provider Business Mailing Address
First Line	:	2311 W 22ND ST
Second Line	:	SUITE 202
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1225
Country	:	US
Telephone Number	:	630-320-1160
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 W 79TH ST
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1554
Country	:	US
Telephone Number	:	708-499-1545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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Directions to “ SUGUNA BABU M.D.” Practice Location

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