Healthcare Provider Details

I. General information

NPI: 1679742076
Provider Name (Legal Business Name): VINOD P UPADHYAYA MD & RAMA S SINGH MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST SUITE 201
OAK LAWN IL
60453-2654
US

IV. Provider business mailing address

4400 W 95TH ST SUITE 201
OAK LAWN IL
60453-2654
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-6626
  • Fax: 708-346-2035
Mailing address:
  • Phone: 708-636-6626
  • Fax: 708-346-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. DIANA BERRERA
Title or Position: OFFICE MANAGER
Credential:
Phone: 708-636-6626