Healthcare Provider Details

I. General information

NPI: 1053583633
Provider Name (Legal Business Name): VAISHALI S LAFITA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GREEN BAY RD DEPT 1332D103
NORTH CHICAGO IL
60064-3048
US

IV. Provider business mailing address

27387 N SAINT MARYS RD
METTAWA IL
60048-9682
US

V. Phone/Fax

Practice location:
  • Phone: 224-610-1536
  • Fax:
Mailing address:
  • Phone: 708-254-0524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD-47326
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD-47839
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-47326
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number51370
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD469135
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberMD-47839
License Number StateIA
# 7
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-121676
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: