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General NPI Number Information
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NPI Number | 1588075451
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Entity Type | Organization
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Legal Business Name | SOLOMON PRIMARY CARE DOCTORS LLC
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 645 S CENTRAL AVE 6TH FLOOR
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City | CHICAGO
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State | IL
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Zip | 60644-5059
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Country | US
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Telephone | 708-854-5579
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Fax | 773-854-5587
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Provider Business Mailing Address
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Address Line | 7205 BENTLEY AVE
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City | DARIEN
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State | IL
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Zip | 60561-4145
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Country | US
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Telephone |
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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. DEENADAYAL GADDAM
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Credential | M.D
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Telephone | 708-769-0677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036084144
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License Number State | IL
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