Provider Demographics
NPI:1093828212
Name:YETURU, SUDHAKAR R (MD)
Entity Type:Individual
Prefix:
First Name:SUDHAKAR
Middle Name:R
Last Name:YETURU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:708-636-7193
Practice Address - Street 1:1357 W 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2392
Practice Address - Country:US
Practice Address - Phone:773-238-0800
Practice Address - Fax:773-881-7239
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-085168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF63431Medicare UPIN