Malladi, Madhusudan R

Malladi, Madhusudan R is an individual health care provider with primary practice located at 1036 W Stephenson St , Freeport IL 61032-4865. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Malladi, Madhusudan R can be contacted via phone (815) 599-6000.

Contact Information

Primary practice address
1036 W Stephenson St Freeport IL 61032-4865
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 036088380 Illinois

Profile Details

NPI number 1376515064
LBN Legal business name Malladi, Madhusudan R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 6th, 2006
Last updated Oct 23rd, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376515064 NPPES
Illinois MEDICAID 036088380

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