MEDICARE: MADHAVI S DESHMUKH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA180692	OR
2	363A00000X	Physician Assistant	010759	NY
3	363A00000X	Physician Assistant	085002902	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA180692	OTHER	OR	MEDICAL LICENSE

General Provider Information

NPI Number	:	1023165362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADHAVI S DESHMUKH PA-C

Provider Business Mailing Address
First Line	:	2077 N CLYBOURN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4003
Country	:	US
Telephone Number	:	773-886-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2077 N CLYBOURN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4003
Country	:	US
Telephone Number	:	773-886-1500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	12/04/2024

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Directions to “ MADHAVI S DESHMUKH PA-C” Practice Location

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