| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1017 W Madison St, Chicago, Illinois |
| Authorized Official Name and Position | Deepak Joseph Neduvelil (OWNER) |
| Authorized Official Contact | 6127103883 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1017 W Madison St Chicago IL 60607 Ph: (312) 759-1120 | 1017 W Madison St Chicago IL 60607 Ph: (312) 759-1120 |
| NPI Number | 1093057556 |
|---|---|
| Provider Enumeration Date | 03/22/2013 |
| Last Update Date | 03/22/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093057556 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019027964 (Illinois) | Primary |
| 1223G0001X | Dentist - General Practice | 019027966 (Illinois) | Secondary |
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