Provider Demographics
NPI:1376728113
Name:BEHARA, VENKATA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:Y
Last Name:BEHARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:601 W GOLF RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-4276
Practice Address - Country:US
Practice Address - Phone:847-298-0600
Practice Address - Fax:847-298-6395
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113921207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1616108OtherBCBS GROUP/NUMBER
ILR01101Medicare PIN
ILR01099Medicare PIN