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General NPI Number Information
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NPI Number | 1093828212
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Entity Type | Individual
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Provider Name | SUDHAKAR R. YETURU M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 1357 W 103RD ST
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City | CHICAGO
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State | IL
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Zip | 60643-2392
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Country | US
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Telephone | 773-238-0800
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Fax | 773-881-7239
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Provider Business Mailing Address
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Address Line | 29373 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1293
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Country | US
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Telephone | 847-390-5900
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Fax | 708-636-7193
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-085168
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License Number State | IL
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