MEDICARE: RENUKA HEDDURSHETTI MD

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
1	207RI0200X	Infectious Disease Physician	4301080813	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811003247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENUKA HEDDURSHETTI MD

Provider Business Mailing Address
First Line	:	901 MCCLINTOCK DR
Second Line	:	SUITE 202
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-0871
Country	:	US
Telephone Number	:	888-220-6432
Fax Number	:	630-654-4253

Provider Business Practice Location Address
First Line	:	1854 W AUBURN RD
Second Line	:	SUITE 200
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-3868
Country	:	US
Telephone Number	:	248-853-2323
Fax Number	:	248-853-8890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	11/23/2016

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