Provider Demographics
NPI:1548318488
Name:VEMURI, PREETI (MD)
Entity type:Individual
Prefix:DR
First Name:PREETI
Middle Name:
Last Name:VEMURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 E CONGRESS PKWY
Mailing Address - Street 2:STE M
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6202
Mailing Address - Country:US
Mailing Address - Phone:815-455-0850
Mailing Address - Fax:
Practice Address - Street 1:27790 W HIGHWAY 22 STE 27
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2396
Practice Address - Country:US
Practice Address - Phone:847-649-6000
Practice Address - Fax:847-649-6060
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-101008207QA0401X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101008 1Medicaid
IL510420 L92945Medicare ID - Type Unspecified
H67926Medicare UPIN
IL036101008 1Medicaid