Healthcare Provider Details

I. General information

NPI: 1053481929
Provider Name (Legal Business Name): RITA YADAVA M.D.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SOUTH YORK RD 4150
ELMHURST IL
60126
US

IV. Provider business mailing address

214 INDIAN TRAIL COURT
OAK BROOK IL
60523
US

V. Phone/Fax

Practice location:
  • Phone: 630-530-5577
  • Fax:
Mailing address:
  • Phone: 630-323-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: RITA YADAVA
Title or Position: PRESIDENT
Credential: M.D
Phone: 630-530-5577