Provider Demographics
NPI:1730233297
Name:AVVA, RAJITHA LAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:RAJITHA
Middle Name:LAKSHMI
Last Name:AVVA
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 1:12615 SUFFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464
Mailing Address - Country:US
Mailing Address - Phone:708-448-0161
Mailing Address - Fax:708-362-3766
Practice Address - Street 1:PALOS BEHAVIORAL HEALTH
Practice Address - Street 2:13011 S 104TH AVE
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464
Practice Address - Country:US
Practice Address - Phone:708-448-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623882OtherBC BS