Provider Demographics
NPI:1467646141
Name:GUNDALA, SRILATA (MD)
Entity Type:Individual
Prefix:DR
First Name:SRILATA
Middle Name:
Last Name:GUNDALA
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:PO BOX 4535
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-4535
Mailing Address - Country:US
Mailing Address - Phone:219-682-7727
Mailing Address - Fax:630-214-0110
Practice Address - Street 1:950 N YORK RD STE 201A
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-8609
Practice Address - Country:US
Practice Address - Phone:630-560-0121
Practice Address - Fax:630-214-0110
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.124518207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
102403Medicare UPIN