Healthcare Provider Details

I. General information

NPI: 1699205229
Provider Name (Legal Business Name): APARNA DEVI YEPURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

3620 HARBOR LN
QUINCY IL
62305-8443
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-0003
  • Fax:
Mailing address:
  • Phone: 571-524-5187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.157034
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: