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General NPI Number Information
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NPI Number | 1508018326
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Entity Type | Organization
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Legal Business Name | BAPUSHETTY MADOORI MD SC
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Dates
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Enumeration Date | 10/13/2008
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Last Update Date | 10/13/2008
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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 | 708-590-9805
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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 | 708-590-9805
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BAPUSHETTY MADOORI
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Credential | M.D.
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Telephone | 708-590-9805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036057250
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License Number State | IL
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