Gumidyala, Eshwar
Gumidyala, Eshwar is an individual health care provider with primary practice located at 500 Coventry Ln Suite 205, Crystal Lake IL 60014-7579. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Gumidyala, Eshwar can be contacted via phone (815) 455-7100.Contact Information
Primary practice address
500 Coventry Ln Suite 205
Crystal Lake IL 60014-7579
Phone: (815) 455-7100
Fax: (815) 455-3951
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 036-094022 | Illinois |
Profile Details
| NPI number | 1891794137 |
|---|---|
| LBN Legal business name | Gumidyala, Eshwar |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 19th, 2005 |
| Last updated | Jul 5th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891794137 | NPPES |
| Illinois | MEDICAID | 036094022 |
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