Healthcare Provider Details

I. General information

NPI: 1164471058
Provider Name (Legal Business Name): ANURADHA KODURI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE SUITE 635/645
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

5140 N CALIFORNIA AVE SUITE 635/645
CHICAGO IL
60625-3645
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-7787
  • Fax: 773-878-0788
Mailing address:
  • Phone: 773-878-7787
  • Fax: 773-878-0788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: