Provider Demographics
NPI:1912930322
Name:GORLA, MADHU SR (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHU
Middle Name:SR
Last Name:GORLA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2640 PATRIOT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8075
Mailing Address - Country:US
Mailing Address - Phone:847-510-6000
Mailing Address - Fax:847-832-0905
Practice Address - Street 1:2640 PATRIOT BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8075
Practice Address - Country:US
Practice Address - Phone:847-510-6000
Practice Address - Fax:847-832-0905
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2009-03-17
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Provider Licenses
StateLicense IDTaxonomies
IL036-105622207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG65985Medicare UPIN
IL918400Medicare ID - Type Unspecified