Provider Demographics
NPI:1205818085
Name:KANDULA, ARUNA (MD)
Entity Type:Individual
Prefix:
First Name:ARUNA
Middle Name:
Last Name:KANDULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 GOLF RD STE 302
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-7900
Mailing Address - Country:US
Mailing Address - Phone:847-296-8151
Mailing Address - Fax:847-296-3915
Practice Address - Street 1:9301 GOLF RD STE 302
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-7900
Practice Address - Country:US
Practice Address - Phone:847-296-8151
Practice Address - Fax:847-296-3915
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-104217-1Medicaid
IL036-104217-1Medicaid
ILK18082/357801Medicare ID - Type Unspecified