Individual
MAHESH VADALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10458 S PULASKI RD, OAK LAWN, IL 60453-4933
(708) 636-1818
(708) 636-2151
Mailing address
PO BOX 388320, CHICAGO, IL 60638-8320
(773) 767-4600
(773) 767-8320
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036086617
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031601474
BLUE SHIELD
IL
05
—
036086617
—
IL
01
—
110152131
RAILROAD MEDICARE
—
Enumeration date
07/19/2006
Last updated
12/31/2021
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