Individual
DR. MAITRAYEE SUNDARESAN VADALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12251 S 80TH AVE STE 1520, PALOS HEIGHTS, IL 60463-1290
(708) 923-4200
(708) 923-4201
Mailing address
12251 S 80TH AVE STE 1520, PALOS HEIGHTS, IL 60463-1290
(708) 923-4200
(708) 923-4201
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036102767
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102767
—
IL
01
—
21622931
BCBS GROUP #
ID
01
—
CI8250
PALMETTO GBA GROUP #
IL
01
—
P00157926
PALMETTO GBA INDIVIDUAL #
IL
Enumeration date
08/26/2005
Last updated
11/30/2023
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