Provider Demographics
NPI:1366455529
Name:YALLAPRAGADA, RATHNA K (MD)
Entity Type:Individual
Prefix:DR
First Name:RATHNA
Middle Name:K
Last Name:YALLAPRAGADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6120 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5226
Mailing Address - Country:US
Mailing Address - Phone:630-323-8595
Mailing Address - Fax:630-735-5138
Practice Address - Street 1:621 PLAINFIELD RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5343
Practice Address - Country:US
Practice Address - Phone:630-323-8595
Practice Address - Fax:630-735-5138
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-099711207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH10484Medicare UPIN