MEDICARE: MADHAVI GADDE DMD LTD

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	122300000X	Dentist	019030281	IL

General Provider Information

NPI Number	:	1316495963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADHAVI GADDE DMD LTD

Provider Business Mailing Address
First Line	:	8535 W 79TH ST
Second Line	:
City	:	JUSTICE
State	:	IL
Zip	:	60458-2281
Country	:	US
Telephone Number	:	708-458-7552
Fax Number	:

Provider Business Practice Location Address
First Line	:	8535 W 79TH ST
Second Line	:
City	:	JUSTICE
State	:	IL
Zip	:	60458-2281
Country	:	US
Telephone Number	:	708-458-7552
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MADHAVI GADDE
Credential	:	DMD
Telephone Number	:	708-458-7552

Provider Enumeration Date	:	09/12/2016
Last Update Date	:	09/12/2016

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