Provider Demographics
NPI:1134491053
Name:AGADI, VEDAVATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:VEDAVATHI
Middle Name:
Last Name:AGADI
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 1:338 TRINITY LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2561
Mailing Address - Country:US
Mailing Address - Phone:630-794-0746
Mailing Address - Fax:
Practice Address - Street 1:338 TRINITY LN
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2561
Practice Address - Country:US
Practice Address - Phone:630-794-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056185208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice