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NPI Code Detail

MEDICARE: DR. MADHUPA SUD M.D.

MEDICARE: DR. MADHUPA SUD M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistIL

General Provider Information

NPI Number : 1215979729
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MADHUPA SUD M.D.
Provider Business Mailing Address
First Line : 192 ASHTON DR
Second Line :
City : BURR RIDGE
State : IL
Zip : 60527-0306
Country : US
Telephone Number : 630-325-1177
Fax Number :
Provider Business Practice Location Address
First Line : 45 W 111TH ST
Second Line : SUITE 203
City : CHICAGO
State : IL
Zip : 60628-4200
Country : US
Telephone Number : 773-995-3460
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2006
Last Update Date : 07/08/2007

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