Provider Demographics
NPI:1427623503
Name:DUVVADA, SURESH (MD)
Entity type:Individual
Prefix:DR
First Name:SURESH
Middle Name:
Last Name:DUVVADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N WALL ST STE B302
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2940
Mailing Address - Country:US
Mailing Address - Phone:815-329-6500
Mailing Address - Fax:
Practice Address - Street 1:350 N WALL ST STE B302
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2901
Practice Address - Country:US
Practice Address - Phone:815-329-6500
Practice Address - Fax:815-348-6213
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036168734207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine