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General NPI Number Information
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NPI Number | 1902126030
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Entity Type | Organization
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Legal Business Name | V BHOOPAL MD,SC
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 06/11/2010
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Provider Practice Location Address
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Address Line | 12800 S RIDGELAND AVE SUITE E
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-2390
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Country | US
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Telephone | 708-388-4911
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Fax | 708-388-4933
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Provider Business Mailing Address
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Address Line | 12800 S RIDGELAND AVE SUITE E
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-2390
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Country | US
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Telephone | 708-388-4911
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Fax | 708-388-4933
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Authorized Official
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Title or Position | FAMILY PRACTICE
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Name | DR. VASIREDDY BHOOPAL
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Credential | MD
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Telephone | 708-388-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 036056748
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License Number State | IL
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