BAPUSHETTY MADOORI MD SC NPI 1508018326

NPI Information

NPI: 1508018326
Provider Name: BAPUSHETTY MADOORI MD SC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
6905 S WENTWORTH AVE
CHICAGO, IL
ZIP 60621
Phone: (708) 590-9805
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BAPUSHETTY MADOORI MD SC is a primary care clinic center in Chicago, IL. BAPUSHETTY MADOORI MD SC NPI is 1508018326. The provider is registered as an organization entity type.

The provider's business location address is:

6905 S WENTWORTH AVE
CHICAGO, IL
ZIP 60621-734
Phone: (708) 590-9805

The provider's authorized official is Bapushetty Madoori .
The authorized official title is President and has the following contact phone number (708) 590-9805.

The enumeration date for this NPI number is 10/13/2008 and was last updated on 10/13/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	036057250	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	628410	MEDICARE PIN	ILLINOIS
2	D14061	MEDICARE UPIN
3	D14061	MEDICARE UPIN	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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