Provider Demographics
NPI:1841391950
Name:VYAS, HARSHAVADAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:HARSHAVADAN
Middle Name:J
Last Name:VYAS
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 1:1013 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2039
Mailing Address - Country:US
Mailing Address - Phone:815-433-3331
Mailing Address - Fax:815-433-3344
Practice Address - Street 1:1013 CLINTON ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2039
Practice Address - Country:US
Practice Address - Phone:815-433-3331
Practice Address - Fax:815-433-3344
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL910811Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
ILE19365Medicare UPIN