Provider Demographics
NPI:1467530972
Name:RAGHU R VOLLALA MD SC
Entity Type:Organization
Organization Name:RAGHU R VOLLALA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHU
Authorized Official - Middle Name:RAM
Authorized Official - Last Name:VOLLALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-241-1495
Mailing Address - Street 1:6084 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2747
Mailing Address - Country:US
Mailing Address - Phone:773-767-2461
Mailing Address - Fax:
Practice Address - Street 1:6084 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2747
Practice Address - Country:US
Practice Address - Phone:773-767-2461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42214Medicare UPIN
IL201022Medicare ID - Type Unspecified