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General NPI Number Information
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NPI Number | 1851425383
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Entity Type | Individual
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Provider Name | MADHURI THOTA M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 4009 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60613-2110
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Country | US
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Telephone | 773-275-2586
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Fax |
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Provider Business Mailing Address
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Address Line | 14 LAKE ST
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City | OAK PARK
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State | IL
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Zip | 60302-2606
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Country | US
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Telephone | 708-383-0113
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Fax | 708-383-9911
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036106024
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 036.106024
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-106024
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License Number State | IL
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