Individual
AMITHA MADHURI AVASARALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-5140
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036.164758
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2019
Last updated
05/25/2023
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