Healthcare Provider Details

I. General information

NPI: 1932303674
Provider Name (Legal Business Name): VINOD HAVALAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 W DEMPSTER ST
PARK RIDGE IL
60068-1110
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-5313
  • Fax: 847-723-2325
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number036130990
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: