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General NPI Number Information
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NPI Number | 1790737781
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Entity Type | Individual
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Provider Name | VENKATA BUDDHARAJU M.D., F.C.C.P.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 840 W IRVING PARK RD 305
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City | CHICAGO
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State | IL
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Zip | 60613
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Country | US
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Telephone | 773-975-6775
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Fax | 773-975-1089
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Provider Business Mailing Address
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Address Line | 2180 DE COOK AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-1538
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Country | US
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Telephone | 773-505-3071
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Fax | 773-975-1089
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-089871
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 036089871
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License Number State | IL
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