Provider Demographics
NPI:1003478421
Name:PADURI, SWETHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SWETHA
Middle Name:
Last Name:PADURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 GREEN BAY ROAD
Mailing Address - Street 2:1.363A-BSB
Mailing Address - City:NORTHERN ILLINOIS
Mailing Address - State:IL
Mailing Address - Zip Code:60064-5412
Mailing Address - Country:US
Mailing Address - Phone:847-578-3227
Mailing Address - Fax:
Practice Address - Street 1:3333 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3037
Practice Address - Country:US
Practice Address - Phone:847-578-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.160602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.160602OtherPERMANENT LICENSE NO