Provider Demographics
NPI:1285601872
Name:GADDE, HARI P (MD)
Entity type:Individual
Prefix:
First Name:HARI
Middle Name:P
Last Name:GADDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HARIPRASAD
Other - Middle Name:
Other - Last Name:GADDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:330 MADISON ST
Mailing Address - Street 2:L11
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6569
Mailing Address - Country:US
Mailing Address - Phone:815-744-5864
Mailing Address - Fax:815-744-5862
Practice Address - Street 1:330 MADISON ST
Practice Address - Street 2:L11
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6569
Practice Address - Country:US
Practice Address - Phone:815-744-5864
Practice Address - Fax:815-744-5862
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089302207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
303521OtherWELLCARE
IL036089302Medicaid
290015414OtherPALMETTO GBA-RAILROAD MED
IL09905905OtherBLUECROSS BLUESHIELD
IL7524536546043501Medicaid
IL353860Medicare ID - Type UnspecifiedMEDICARE NUMBER
IL7524536546043501Medicaid