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General NPI Number Information
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NPI Number | 1033478847
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Entity Type | Individual
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Provider Name | SESHAGIRI RAO VAVILIKOLANU MD
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Gender | Male
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 161 E NORTH AVE
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City | NORTHLAKE
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State | IL
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Zip | 60164-2523
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Country | US
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Telephone | 989-225-6493
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Fax |
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Provider Business Mailing Address
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Address Line | 165 1/2 E NORTH AVE
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City | NORTHLAKE
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State | IL
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Zip | 60164-2527
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Country | US
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Telephone | 989-225-6493
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 036070313
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License Number State | IL
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