Provider Demographics
NPI:1528089687
Name:NAIDU, GURRAMKONDA (MD)
Entity type:Individual
Prefix:MRS
First Name:GURRAMKONDA
Middle Name:
Last Name:NAIDU
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 1:5000 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60682-0001
Mailing Address - Country:US
Mailing Address - Phone:309-672-4582
Mailing Address - Fax:309-672-4552
Practice Address - Street 1:120 NE GLEN OAK AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-4314
Practice Address - Country:US
Practice Address - Phone:309-672-4582
Practice Address - Fax:309-672-4552
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058664207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001011OtherHEALTH ALLIANCE
IL0116OtherBLUE CROSS/BLUE SHIELD
IL370661223401Medicaid
ILA61636OtherJOHN DEERE
IL115958OtherHEALTHLINK
IL370661223001Medicaid
IL0116OtherBLUE CROSS/BLUE SHIELD
ILG16092Medicare UPIN