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General NPI Number Information
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NPI Number | 1366451577
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Entity Type | Individual
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Provider Name | SUMA REDDY KAKI M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 899 S WEBER RD SUITE G
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City | BOLINGBROOK
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State | IL
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Zip | 60490-5488
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Country | US
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Telephone | 630-226-1800
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Fax | 630-226-4226
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Provider Business Mailing Address
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Address Line | 899 S WEBER RD SUITE G
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City | BOLINGBROOK
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State | IL
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Zip | 60490-5488
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Country | US
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Telephone | 630-226-1800
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Fax | 630-226-4226
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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 | 036-114593
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License Number State | IL
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