Provider Demographics
NPI:1629020904
Name:CHADALAVADA, KRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:CHADALAVADA
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 1:100 E. LEFEVRE ROAD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-1279
Mailing Address - Country:US
Mailing Address - Phone:815-625-0400
Mailing Address - Fax:815-625-2747
Practice Address - Street 1:100 E. LEFEVRE ROAD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-1279
Practice Address - Country:US
Practice Address - Phone:815-625-0400
Practice Address - Fax:815-625-2747
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42943Medicare UPIN
ILK38988Medicare PIN