Individual
VENKAT VAVILALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
90 W 86TH AVE, MERRILLVILLE, IN 46410-7086
(219) 791-1555
(219) 791-1560
Mailing address
120 W 22ND ST, OAK BROOK, IL 60523-1557
(630) 573-5000
(630) 491-5472
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
01057614A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000285124
ANTHEM BCBS NUMBER
IN
05
—
100082060
—
IN
05
—
200442790
—
IN
01
—
P0037143
RR MEDICARE NUMBER
IN
Enumeration date
07/01/2005
Last updated
12/13/2022
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