Healthcare Provider Details

I. General information

NPI: 1114505534
Provider Name (Legal Business Name): SAROJA GUNTUPALLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BLACK OAK DR STE 400
MEDFORD OR
97504-8491
US

IV. Provider business mailing address

2825 E BARNETT RD # MSS
MEDFORD OR
97504-8332
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-8873
  • Fax: 541-789-2173
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125078137
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: