Individual
PADMAJA VITTAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-4056
(630) 933-5868
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-4056
(630) 933-5868
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
036133023
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE PTAN GROUP
IL
01
—
F400299312
MEDICARE PTAN INDIVIDUAL
IL
Enumeration date
05/13/2009
Last updated
02/28/2018
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