Provider Demographics
NPI:1184318545
Name:YARLAGADDA, PREETHAM
Entity type:Individual
Prefix:
First Name:PREETHAM
Middle Name:
Last Name:YARLAGADDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 TOWNLEY CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8147
Mailing Address - Country:US
Mailing Address - Phone:330-245-6037
Mailing Address - Fax:
Practice Address - Street 1:5425 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-2342
Practice Address - Country:US
Practice Address - Phone:773-378-3347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program