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General NPI Number Information
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NPI Number | 1255771689
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Entity Type | Individual
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Provider Name | TOM PAUL VADAKARA MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2013
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 600 S PAULINA ST STE 527
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City | CHICAGO
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State | IL
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Zip | 60612-3806
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Country | US
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Telephone | 312-942-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 12040 NE 128TH ST MS-50
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City | KIRKLAND
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State | WA
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Zip | 98034
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Country | US
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Telephone | 425-899-1920
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD60937807
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036140761
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License Number State | IL
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