Basic Information
| Provider Information | |||||||||
| NPI: | 1114131752 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOPARAJU | ||||||||
| FirstName: | MADHAVI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 528 W OAKDALE AVE | ||||||||
| Address2: | APT # 425 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606575751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122135642 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2900 N LAKE SHORE DR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606575640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736653000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 11/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125050613 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.