Healthcare Provider Details

I. General information

NPI: 1043417819
Provider Name (Legal Business Name): VIJAYASREE PALERU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIJAYASREE KUDITHIPUDI M.D.

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 N KNOXVILLE AVE
PEORIA IL
61614-5016
US

IV. Provider business mailing address

5405 N KNOXVILLE AVE
PEORIA IL
61614-5016
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-4410
  • Fax: 309-692-4730
Mailing address:
  • Phone: 309-691-4410
  • Fax: 309-692-4730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036155415
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01068269A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number036155415
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: