Healthcare Provider Details

I. General information

NPI: 1992558563
Provider Name (Legal Business Name): SINDHU ANISHA GUJJARI MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SINDHU LAXMI ANISHA GUJJARI

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 08/28/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 MEDICAL CENTER DRIVE
MCHENRY IL
60050
US

IV. Provider business mailing address

4201 MEDICAL CENTER DRIVE
MCHENRY IL
60050
US

V. Phone/Fax

Practice location:
  • Phone: 815-759-4726
  • Fax:
Mailing address:
  • Phone: 815-759-4726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.084999
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: