Healthcare Provider Details

I. General information

NPI: 1497249049
Provider Name (Legal Business Name): AVINASH INABATHULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 GROSS POINT RD STE 2900
SKOKIE IL
60076-5006
US

IV. Provider business mailing address

9650 GROSS POINT RD STE 2900
SKOKIE IL
60076-5006
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-1159
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number125072360
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: