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General NPI Number Information
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NPI Number | 1467646141
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Entity Type | Individual
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Provider Name | SRILATA GUNDALA M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 950 N YORK RD STE 201A
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City | HINSDALE
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State | IL
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Zip | 60521-8609
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Country | US
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Telephone | 630-560-0121
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Fax | 630-214-0110
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Provider Business Mailing Address
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Address Line | PO BOX 4535
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City | OAK BROOK
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State | IL
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Zip | 60522-4535
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Country | US
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Telephone | 219-682-7727
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Fax | 630-214-0110
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 036.124518
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License Number State | IL
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