Basic Information
| Provider Information | |||||||||
| NPI: | 1225340045 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANEGONDHI SUDHINDRA | ||||||||
| FirstName: | PRAVEEN R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5401 N KNOXVILLE AVE STE 412B | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616145082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096896093 | ||||||||
| FaxNumber: | 3095245599 | ||||||||
| Practice Location | |||||||||
| Address1: | 5401 N KNOXVILLE AVE STE 412B | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616145082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096896093 | ||||||||
| FaxNumber: | 3095245599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 036.142107 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RC0200X | 036.142107 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.