Provider Demographics
NPI:1053583633
Name:LAFITA, VAISHALI S (MD)
Entity type:Individual
Prefix:
First Name:VAISHALI
Middle Name:S
Last Name:LAFITA
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 1:27387 N SAINT MARYS RD
Mailing Address - Street 2:
Mailing Address - City:METTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:60048-9682
Mailing Address - Country:US
Mailing Address - Phone:708-254-0524
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY RD DEPT 1332D103
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-1536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-473262085B0100X, 2085R0202X
IAMD-478392085N0700X, 2085U0001X
WI513702085R0202X
IL036-1216762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053583633OtherNPI #
IL036121676Medicaid
IL202926OtherGROUP PTAN
IL212545OtherGROUP PTAN
IL202926014Medicare PIN
1053583633OtherNPI #