Healthcare Provider Details

I. General information

NPI: 1255656948
Provider Name (Legal Business Name): SUREKHA BODDIPALLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUREKHA MADUDULA MD

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N MELVIN ST
GIBSON CITY IL
60936-1477
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 217-784-2332
  • Fax: 217-680-0005
Mailing address:
  • Phone: 630-469-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036140535
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: