Provider Demographics
NPI:1245082023
Name:VELAGAPUDI, SWETHA KIRAN
Entity type:Individual
Prefix:
First Name:SWETHA
Middle Name:KIRAN
Last Name:VELAGAPUDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 WATERROCK DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5532
Mailing Address - Country:US
Mailing Address - Phone:630-450-3826
Mailing Address - Fax:
Practice Address - Street 1:4220 W 95TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3072
Practice Address - Country:US
Practice Address - Phone:708-398-0287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125.084185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program