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General NPI Number Information
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NPI Number | 1992123004
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Entity Type | Organization
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Legal Business Name | BHAVANA VAIDYA MD LLC
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 10601 S KILBOURN AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-5341
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Country | US
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Telephone | 773-962-4025
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Fax |
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Provider Business Mailing Address
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Address Line | 10601 S KILBOURN AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-5341
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Country | US
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Telephone | 773-962-4025
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Fax |
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Authorized Official
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Title or Position | MD
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Name | BHAVANA VAIDYA
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Credential |
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Telephone | 773-962-4025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 036066303
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License Number State | IL
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