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NPI Code Detail

MEDICARE: VASANTHA NAIDU M.D.

MEDICARE: VASANTHA NAIDU M.D.
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
1207Q00000XFamily Medicine Physician036-056679IL
2208000000XPediatrics Physician036-056679IL

General Provider Information

NPI Number : 1760546329
Entity Type Code : Individual
Provider Name (Legal Business Name) : VASANTHA NAIDU M.D.
Provider Business Mailing Address
First Line : 654 E 47TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4224
Country : US
Telephone Number : 773-624-4800
Fax Number : 773-624-5028
Provider Business Practice Location Address
First Line : 654 E 47TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4224
Country : US
Telephone Number : 773-624-4800
Fax Number : 773-624-5028
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 05/14/2012

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Directions to “ VASANTHA NAIDU M.D.” Practice Location

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