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Individual

DR. MEHER BALA MEDAVARAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

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
207Q00000X
Family Medicine Physician
Primary
036072434
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036072434
IL
01
09921620
BCBS
Enumeration date
11/01/2006
Last updated
01/31/2014
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