Provider Demographics
NPI:1073613378
Name:GULIANI, MADHU BALA (MD)
Entity type:Individual
Prefix:DR
First Name:MADHU
Middle Name:BALA
Last Name:GULIANI
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 1:5140 N CALIFORNIA AVE STE 630
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-7066
Mailing Address - Country:US
Mailing Address - Phone:773-728-0929
Mailing Address - Fax:773-728-3524
Practice Address - Street 1:5140 N CALIFORNIA AVE STE 630
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-7066
Practice Address - Country:US
Practice Address - Phone:773-728-0929
Practice Address - Fax:773-728-3524
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062955207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC41404Medicare UPIN
IL767250Medicare PIN