Provider Demographics
NPI:1598845554
Name:UPADHYAYA, VARSHA (MD)
Entity Type:Individual
Prefix:
First Name:VARSHA
Middle Name:
Last Name:UPADHYAYA
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 1:4400 W 95TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2657
Mailing Address - Country:US
Mailing Address - Phone:708-636-6626
Mailing Address - Fax:708-346-2035
Practice Address - Street 1:4400 W 95TH ST STE 202
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2657
Practice Address - Country:US
Practice Address - Phone:708-636-6626
Practice Address - Fax:708-346-2035
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-057280174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360572580Medicaid
IL602400Medicare ID - Type Unspecified
D13786Medicare UPIN