Provider Demographics
NPI:1366638181
Name:SEETHARAM, SANDHYA (MD,)
Entity Type:Individual
Prefix:DR
First Name:SANDHYA
Middle Name:
Last Name:SEETHARAM
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 1:802 STATION BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-2033
Mailing Address - Country:US
Mailing Address - Phone:312-315-2257
Mailing Address - Fax:
Practice Address - Street 1:11173 VILLA CANALES LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:312-315-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-16
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC146553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine