Healthcare Provider Details

I. General information

NPI: 1699797548
Provider Name (Legal Business Name): VENKATA MOPARTHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E SIXTH ST
CLIFTON IL
60927
US

IV. Provider business mailing address

9223 W ST FRANCIS ROAD
FRANKFORT IL
60423
US

V. Phone/Fax

Practice location:
  • Phone: 815-936-5167
  • Fax: 815-937-8246
Mailing address:
  • Phone: 815-806-3111
  • Fax: 815-464-2621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: