Provider Demographics
NPI:1114983798
Name:GONA, VASANTHA L (MD)
Entity Type:Individual
Prefix:DR
First Name:VASANTHA
Middle Name:L
Last Name:GONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2128 MIDLANDS CT
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3199
Mailing Address - Country:US
Mailing Address - Phone:815-756-1434
Mailing Address - Fax:815-756-4766
Practice Address - Street 1:2128 MIDLANDS CT
Practice Address - Street 2:SUITE 106
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3199
Practice Address - Country:US
Practice Address - Phone:815-756-1434
Practice Address - Fax:815-756-4766
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME95614174400000X
IL036099204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist