Provider Demographics
NPI:1043292121
Name:VEERRAJU, KUCHIPUDI (MD)
Entity type:Individual
Prefix:
First Name:KUCHIPUDI
Middle Name:
Last Name:VEERRAJU
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 1:475 N FARNSWORTH AVE
Mailing Address - Street 2:AURORA MEDICAL CLINIC
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-3004
Mailing Address - Country:US
Mailing Address - Phone:630-898-0022
Mailing Address - Fax:630-898-2933
Practice Address - Street 1:475 N FARNSWORTH AVE
Practice Address - Street 2:AURORA MEDICAL CLINIC
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-3004
Practice Address - Country:US
Practice Address - Phone:630-898-0022
Practice Address - Fax:630-898-2933
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G29429Medicare UPIN