Healthcare Provider Details

I. General information

NPI: 1225035041
Provider Name (Legal Business Name): VED P YADAVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S. YORK RD
ELMHURST IL
60126
US

IV. Provider business mailing address

172 SCHILLER
ELMHURST IL
60126-2885
US

V. Phone/Fax

Practice location:
  • Phone: 630-941-2638
  • Fax: 630-941-2642
Mailing address:
  • Phone: 630-941-2638
  • Fax: 630-941-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036052240
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: