Provider Demographics
NPI:1306094842
Name:YEDAVALLI, NINA (MD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:YEDAVALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:UNDEVIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1301 COPPERFIELD AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-2054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 COPPERFIELD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-2054
Practice Address - Country:US
Practice Address - Phone:815-740-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112219207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology