Provider Demographics
NPI:1871514315
Name:UPPUTURI, RADHA KRISHNA (MD)
Entity type:Individual
Prefix:
First Name:RADHA
Middle Name:KRISHNA
Last Name:UPPUTURI
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 1:234 N ADAMS STREET
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28375 DAVIS PKWY
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555
Practice Address - Country:US
Practice Address - Phone:630-225-4060
Practice Address - Fax:630-315-1505
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115736207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN GROUP
ILF400228127OtherMEDICARE PTAN INDIVIDUAL
ILBU9797296OtherDEA
IL036-115736OtherLICENSE