Healthcare Provider Details

I. General information

NPI: 1124919923
Provider Name (Legal Business Name): RAGHAV REDDY PALLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S CENTRAL AVE
CHICAGO IL
60644-5059
US

IV. Provider business mailing address

208 INDIAN TRAIL RD
OAK BROOK IL
60523-2795
US

V. Phone/Fax

Practice location:
  • Phone: 773-626-4300
  • Fax:
Mailing address:
  • Phone: 630-399-2812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.087016
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: