Healthcare Provider Details

I. General information

NPI: 1215556477
Provider Name (Legal Business Name): TEJA RAGHAVA ALAPATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10436 SOUTHWEST HWY
CHICAGO RIDGE IL
60415-2282
US

IV. Provider business mailing address

10436 SOUTHWEST HWY
CHICAGO RIDGE IL
60415-2282
US

V. Phone/Fax

Practice location:
  • Phone: 708-873-0088
  • Fax:
Mailing address:
  • Phone: 708-873-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036169573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: