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General NPI Number Information
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NPI Number | 1912521584
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Entity Type | Individual
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Provider Name | SINDHUJA MUDDAM
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Gender | Female
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Dates
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Enumeration Date | 05/30/2020
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 3220 W IL ROUTE 60
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City | MUNDELEIN
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State | IL
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Zip | 60060-4271
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Country | US
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Telephone | 847-837-8442
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Fax |
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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 |
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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 | 0101278440
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MT220688
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036.169906
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License Number State | IL
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