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General NPI Number Information
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NPI Number | 1356420368
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Entity Type | Individual
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Provider Name | SUJATHA ANASAPURAPU RAO M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 3255 CINNEBAR PT STE 1
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City | CARBONDALE
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State | IL
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Zip | 62901-5203
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Country | US
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Telephone | 618-303-2712
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Fax |
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Provider Business Mailing Address
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Address Line | 3255 CINNEBAR PT
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City | CARBONDALE
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State | IL
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Zip | 62901-5203
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Country | US
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Telephone | 618-303-2712
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 201307515
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 036111928
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License Number State | IL
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