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General NPI Number Information
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NPI Number | 1487050654
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Entity Type | Individual
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Provider Name | DR. PRANJALI VADGAONKAR
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Gender | Female
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Dates
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Enumeration Date | 11/14/2014
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 1106 NEAL AVE
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City | JOLIET
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State | IL
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Zip | 60433-2548
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Country | US
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Telephone | 815-727-8869
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 NEAL AVE
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City | JOLIET
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State | IL
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Zip | 60433-2548
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Country | US
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Telephone | 815-727-8869
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036.138648
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License Number State | IL
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