MEDICARE: AVD MEDICAL SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1215405758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVD MEDICAL SC

Provider Business Mailing Address
First Line	:	PO BOX 9237
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60567-0237
Country	:	US
Telephone Number	:	630-964-7006
Fax Number	:	630-964-7082

Provider Business Practice Location Address
First Line	:	3825 HIGHLAND AVE STE 3D
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1549
Country	:	US
Telephone Number	:	630-964-7006
Fax Number	:	630-964-7082

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANIL VAMSI DOPPALAPUDI
Credential	:	MD
Telephone Number	:	630-964-7006

Provider Enumeration Date	:	11/02/2018
Last Update Date	:	12/21/2021

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Directions to “AVD MEDICAL SC ” Practice Location

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