Provider Demographics
NPI:1588720999
Name:VELAGAPUDI, ANITA SURESH (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:SURESH
Last Name:VELAGAPUDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:YALAMANCHILLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1256 WATERFORD DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:630-499-2404
Mailing Address - Fax:630-499-2399
Practice Address - Street 1:472 ROUTE 47
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-8107
Practice Address - Country:US
Practice Address - Phone:630-466-6000
Practice Address - Fax:630-466-6001
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086960OtherSTATE LICENSE
IL036086960OtherSTATE LICENSE