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General NPI Number Information
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NPI Number | 1164454914
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Entity Type | Individual
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Provider Name | SUGUNA BABU M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4901 W 79TH ST
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City | BURBANK
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State | IL
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Zip | 60459-1554
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Country | US
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Telephone | 708-499-1545
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Fax |
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Provider Business Mailing Address
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Address Line | 2311 W 22ND ST SUITE 202
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City | OAK BROOK
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State | IL
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Zip | 60523-1225
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Country | US
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Telephone | 630-320-1160
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | IL
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