Provider Demographics
NPI:1679742076
Name:VINOD P UPADHYAYA MD & RAMA S SINGH MD
Entity Type:Organization
Organization Name:VINOD P UPADHYAYA MD & RAMA S SINGH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-636-6626
Mailing Address - Street 1:4400 W 95TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2654
Mailing Address - Country:US
Mailing Address - Phone:708-636-6626
Mailing Address - Fax:708-346-2035
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:708-636-6626
Practice Address - Fax:708-346-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1811050495OtherNPI
IL1902986961OtherNPI