Provider Demographics
NPI:1922324383
Name:MANDIYAN, VIDYA S (MD)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:S
Last Name:MANDIYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIDYA
Other - Middle Name:SREEKALA
Other - Last Name:MANDIYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2000 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7222
Mailing Address - Country:US
Mailing Address - Phone:866-565-8607
Mailing Address - Fax:630-898-3427
Practice Address - Street 1:2000 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7222
Practice Address - Country:US
Practice Address - Phone:866-565-8607
Practice Address - Fax:630-898-3427
Is Sole Proprietor?:No
Enumeration Date:2010-04-10
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-133805207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine