Provider Demographics
NPI:1225659444
Name:VELLAICHAMY, GAUTHAM (MD)
Entity type:Individual
Prefix:
First Name:GAUTHAM
Middle Name:
Last Name:VELLAICHAMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W HIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-7220
Mailing Address - Country:US
Mailing Address - Phone:547-884-8096
Mailing Address - Fax:847-884-8125
Practice Address - Street 1:2500 W HIGGINS RD STE 1040
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2049
Practice Address - Country:US
Practice Address - Phone:847-884-8096
Practice Address - Fax:847-884-8125
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036171734207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology