Individual
TEAH QVAVADZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
747 N RUTLEDGE ST FL 4, SPRINGFIELD, IL 62702-6700
(217) 545-8000
(217) 545-1622
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-8000
(217) 545-2101
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036.166578
IL
208600000X
Surgery Physician
MT207459
PA
2086S0129X
Vascular Surgery Physician
Primary
036.166578
IL
Other
Enumeration date
06/12/2014
Last updated
09/24/2024
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