Provider Demographics
NPI:1356393300
Name:ELADASARI, BABU RAO (MD,FACP)
Entity type:Individual
Prefix:DR
First Name:BABU
Middle Name:RAO
Last Name:ELADASARI
Suffix:
Gender:M
Credentials:MD,FACP
Other - Prefix:DR
Other - First Name:BABU
Other - Middle Name:RAO
Other - Last Name:ELADASARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, FACP
Mailing Address - Street 1:559 N WESTGATE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1156
Mailing Address - Country:US
Mailing Address - Phone:217-243-5474
Mailing Address - Fax:217-245-2322
Practice Address - Street 1:559 N WESTGATE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1156
Practice Address - Country:US
Practice Address - Phone:217-243-5474
Practice Address - Fax:217-245-2322
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091905OtherPHYSICIANS LICENSE
IL336053421OtherCONTROLLED SUBSTANCE
IL336053421OtherCONTROLLED SUBSTANCE