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General NPI Number Information
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NPI Number | 1013108059
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Entity Type | Individual
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Provider Name | VIKRAM KANAKAYYA DEVISETTY M.D., M.B.A., M.P.H.
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Gender | Male
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 660 N WESTMORELAND RD
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City | LAKE FOREST
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State | IL
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Zip | 60045-1659
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Country | US
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Telephone | 847-234-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 1195 OAK KNOLL DR
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City | LAKE FOREST
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State | IL
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Zip | 60045-3664
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Country | US
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Telephone | 919-308-4344
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2007015014
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036.125779
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License Number State | IL
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