Individual
DR. VASIREDDY BHOOPAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.,
Contact information
Practice address
12800 S RIDGELAND AVE, SUITE E, PALOS HEIGHTS, IL 60463-2390
(708) 388-4911
(708) 388-4933
Mailing address
14125 SCOTT LN, ORLAND PARK, IL 60462-6117
(708) 466-9039
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
036-056748
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-056748
ILLINOIS LICENCE NUMBER
IL
Enumeration date
08/12/2006
Last updated
07/08/2007
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