1710774013 NPI number — MR. VINAY RAJ KUMAR VERMA MBBS

Table of content: MR. VINAY RAJ KUMAR VERMA MBBS (NPI 1710774013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710774013 NPI number — MR. VINAY RAJ KUMAR VERMA MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERMA
Provider First Name:
VINAY
Provider Middle Name:
RAJ KUMAR
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MBBS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710774013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 NE GLEN OAK AVE INTERNAL MEDICINE RESIDENCY OSF ST.
Provider Second Line Business Mailing Address:
ATTN: MARTI SOKOLOWSKI
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-624-9351
Provider Business Mailing Address Fax Number:
309-655-7732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 NE GLEN OAK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-624-9351
Provider Business Practice Location Address Fax Number:
309-655-7732
Provider Enumeration Date:
04/22/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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