SUDHA CHERUKURI (NPI# 1629126222) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629126222 |
| Entity Type | Individual |
| Full Name | SUDHA CHERUKURI |
| Credential | MD |
| Practice Address |
420 Ne Glen Oak Ave Ste 401 Peoria IL 61603 |
| Mailing Address |
420 Ne Glen Oak Ave Ste 401 Peoria IL 61603-3168 |
| Practice Telephone | 3096768123 |
| Practice Fax Number | 3096768455 |
| Mailing Telephone | 3096768123 |
| Mailing Fax Number | 3096768455 |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2018-10-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
036132128 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036-132128 | 05 | |
| IL | UPIN | 613790006 | 01 |
| Street Address |
420 NE GLEN OAK AVE STE 401 |
| City | PEORIA |
| State | IL |
| Zip Code | 61603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710974597 | Timothy P Oconnor | Transplant Surgery | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603 | 2005-10-05 |
| 1962994707 | Michelle Sue Dehne | Nurse Practitioner | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2018-06-06 |
| 1780060517 | Danae Smith | Nurse Practitioner | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2015-08-04 |
| 1568848497 | Sarah Adams | Nurse Practitioner | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2015-08-03 |
| 1225434772 | Tonya Moore | Registered Nurse | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2014-11-11 |
| 1497172399 | Jill Oberle | Nurse Practitioner | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2014-03-28 |
| 1629344064 | David Edward Houser | Internal Medicine | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2012-03-29 |
| 1538325477 | Raji Jacob | Internal Medicine | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2008-07-30 |
| 1669648309 | Muhammad Waqar Khattak | Internal Medicine | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603 | 2008-05-02 |
| 1982816237 | Anu Vishwanath | Pediatrics | 420 Ne Glen Oak Ave Ste 401, Suite 401, Peoria, IL 61603-3168 | 2007-05-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598362980 | Courtney Klein | Nurse Practitioner | 1306 N. Berkley Ave, Peoria, IL 61603 | 2020-10-08 |
| 1114588217 | Kong Xing Wang | Dentist | 320 East Armstrong Ave, Peoria, IL 61603 | 2019-06-28 |
| 1073015319 | Sara Kristine Rosenbery | Nurse Practitioner | 515 Ne Glen Oak Ave Ste 202, Peoria, IL 61603 | 2018-03-02 |
| 1861860058 | Jennifer Michelle Kelsey | Clinical Nurse Specialist | 420 Ne Glen Oak Avenue, Suite 401, Peoria, IL 61603 | 2015-09-04 |
| 1467859793 | Bonnie Lansing | Counselor | 617 N Gendale Avenue, Behavioral Health Adult Program, Peoria, IL 61603 | 2014-12-02 |
| 1639597172 | Jael K. Mahasi | Counselor | 1800 Ne Perry Avenue, Peoria, IL 61603 | 2014-04-02 |
| 1992054829 | Justin S Ferragut | Radiology | 530 Northeast Glen Oak Avenue, Peoria, IL 61603 | 2012-09-06 |
| 1780952994 | Syed Muhammad Tayyab | Internal Medicine | 828 Ne Glen Oak Ave Apt No208a, Peoria, IL 61603 | 2011-12-02 |
| 1528389079 | St. Francis Medical Center | General Acute Care Hospital | 530 N E Glen Oak Ave, Peoria, IL 61603 | 2010-06-18 |
| 1780810648 | Children's Home Association of Illinois | Voluntary or Charitable | 400 E. Frye, Peoria, IL 61603 | 2009-06-05 |
| Find all providers in zip 61603 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215388855 | Akdhc, LLC-phoenix Access Center 1 | Internal Medicine | 9125 W Thunderbird Rd Ste 105, Peoria, AZ 85381-4921 | 2016-06-24 |
| 1952353633 | Asan M. Ariff Md, PC | Internal Medicine | 13943 N 91st Avenue, Ste H100, Peoria, AZ 85381-3689 | 2006-05-17 |
| 1861486607 | Gurdev Singh | Internal Medicine | 7362 W Thunderbird Road, Peoria, AZ 85381 | 2005-09-08 |
| 1215921135 | Richard P Flick | Internal Medicine | 7362 W Thunderbird Rd, Peoria, AZ 85381 | 2005-09-07 |
| 1023002946 | Mandip S Kang | Internal Medicine | 7362 W. Thunderbird Road, Peoria, AZ 85381 | 2005-09-07 |
| 1932514387 | Kidney Care Center Bloomington LLC | Internal Medicine | 719 Main St, Peoria, IL 61602-1083 | 2014-06-24 |
| 1629344064 | David Edward Houser | Internal Medicine | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2012-03-29 |
| 1730479296 | Roy Kent Bryan | Internal Medicine | 200 E Pennsylvania Ave, Suite 212, Peoria, IL 61603-3089 | 2011-04-18 |
| 1609010883 | Amer Khan | Internal Medicine | 13943 N 91st Ave, Ste H101, Peoria, AZ 85381-3689 | 2009-05-01 |
| 1538325477 | Raji Jacob | Internal Medicine | 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603-3168 | 2008-07-30 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.