Provider Demographics
NPI:1801895867
Name:AVULA, SUNITHA R (MD)
Entity type:Individual
Prefix:MRS
First Name:SUNITHA
Middle Name:R
Last Name:AVULA
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 1:12701 W 143RD ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491
Mailing Address - Country:US
Mailing Address - Phone:708-300-6702
Mailing Address - Fax:
Practice Address - Street 1:12701 W 143RD ST
Practice Address - Street 2:STE 230
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491
Practice Address - Country:US
Practice Address - Phone:708-300-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
L86668Medicare ID - Type Unspecified
G50214Medicare UPIN