Individual
CHANDRAGUPTA S VEDAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 COVENTRY LN, SUITE 205, CRYSTAL LAKE, IL 60014-7579
(815) 455-7100
(815) 455-3951
Mailing address
500 COVENTRY LN, SUITE 205, CRYSTAL LAKE, IL 60014-7579
(815) 455-7100
(815) 455-3951
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036-070389
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036070389
—
IL
01
—
05619771
BCBS
IL
Enumeration date
07/20/2005
Last updated
12/22/2021
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