Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 125.075239 | IL |
Y | 111NI0900X | Internist | 125.075239 | IL |
NPI | 1003478421 |
---|---|
Provider Name | Dr. Swetha Paduri |
First Address | Northern Illinois, IL 60064-5412 |
Second Address | North Chicago, IL 60064-3037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2019 |
Last Update Date | 24/04/2020 |