Provider Demographics
NPI:1861646770
Name:VANGALA, SUGUNAKAR REDDY (MD)
Entity Type:Individual
Prefix:
First Name:SUGUNAKAR
Middle Name:REDDY
Last Name:VANGALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 N PLUM GROVE RD
Mailing Address - Street 2:107
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4688
Mailing Address - Country:US
Mailing Address - Phone:847-666-5031
Mailing Address - Fax:
Practice Address - Street 1:1106 N PLUM GROVE RD
Practice Address - Street 2:107
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4688
Practice Address - Country:US
Practice Address - Phone:847-666-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125054787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine