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Organization

NAPERBROOK MEDICAL CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MEHER BALA MEDAVARAM M.D. (PRESIDENT)
(630) 378-1234
Entity
Organization

Contact information

Practice address
686 W BOUGHTON RD, BOLINGBROOK, IL 60440-1520
(630) 378-1234
(630) 378-1155
Mailing address
686 W BOUGHTON RD, BOLINGBROOK, IL 60440-1520
(630) 378-1234
(630) 378-1155

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
042-007177
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
09921620
BLUECROSS BLUESHIELD
IL
Enumeration date
01/25/2008
Last updated
01/25/2008
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