Healthcare Provider Details

I. General information

NPI: 1992940274
Provider Name (Legal Business Name): TEJASI ADAVADKAR-GHOLAP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TEJASI ADAVADKAR M.D.

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 W MAIN ST STE 100
ST CHARLES IL
60175-1024
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-348-3100
  • Fax: 630-513-0727
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54918-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.125306
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: