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General NPI Number Information
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NPI Number | 1265699615
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Entity Type | Individual
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Provider Name | NEDA MOADDELI M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 12/23/2014
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Provider Practice Location Address
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Address Line | 3701 DOTY RD
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City | WOODSTOCK
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State | IL
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Zip | 60098-7509
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Country | US
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Telephone | 815-334-3170
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Fax |
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Provider Business Mailing Address
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Address Line | 3095 HENRY LN
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156-6761
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Country | US
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Telephone | 224-628-4744
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036.120655
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License Number State | IL
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