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General NPI Number Information
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NPI Number | 1083797864
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Entity Type | Individual
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Provider Name | BAPUSHETTY R MADOORI M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 6905 S WENTWORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60621-3734
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Country | US
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Telephone | 773-994-5607
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Fax |
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Provider Business Mailing Address
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Address Line | 15617 SUNSET RIDGE DR
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City | ORLAND PARK
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State | IL
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Zip | 60462-4925
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Country | US
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Telephone | 708-460-0491
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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 |
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License Number State | IL
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