Provider Demographics
NPI:1720500101
Name:MAHAJAN, SUGANDHI (MD)
Entity Type:Individual
Prefix:
First Name:SUGANDHI
Middle Name:
Last Name:MAHAJAN
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:IMRP COLLEGE OF MEDICINE CARLE FORUM LL, MC- 474
Mailing Address - Street 2:611 WEST PARK STREET
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-7109
Mailing Address - Country:US
Mailing Address - Phone:217-383-3110
Mailing Address - Fax:
Practice Address - Street 1:611 WEST PARK STREET
Practice Address - Street 2:IMRP COLLEGE OF MEDICINE CARLE FORUM LL, MC- 474
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-7109
Practice Address - Country:US
Practice Address - Phone:217-383-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.070106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine