Provider Demographics
NPI:1124087788
Name:V.R. KUCHIPUDI, M.D., S.C.
Entity type:Organization
Organization Name:V.R. KUCHIPUDI, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:V.R.
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHIPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-718-0200
Mailing Address - Street 1:1730 PARK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2688
Mailing Address - Country:US
Mailing Address - Phone:630-718-0200
Mailing Address - Fax:630-718-0900
Practice Address - Street 1:3101 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1236
Practice Address - Country:US
Practice Address - Phone:708-387-0121
Practice Address - Fax:708-387-0129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02201193OtherBLUE CROSS / BLUE SHIELD
204158Medicare ID - Type Unspecified
202061Medicare ID - Type Unspecified
204171Medicare ID - Type Unspecified
202063Medicare ID - Type Unspecified
IL536640Medicare ID - Type Unspecified
207635Medicare ID - Type Unspecified