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Organization
VIJAYALAKSHMI THOTA DO SC
Active
Organization
VIJAYALAKSHMI THOTA DO SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIJAYALAKSHMI THOTA DO (OWNER/PHYSICIAN)
(708) 349-6713
Entity
Organization
Contact information
Practice address
15300 WEST AVE, SUITE 303, ORLAND PARK, IL 60462-4600
(708) 349-6713
Mailing address
15300 WEST AVE, SUITE 303, ORLAND PARK, IL 60462-4600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036088719
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001627062
BC/BS
IL
05
—
036088719
—
IL
Enumeration date
09/10/2007
Last updated
07/16/2008
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