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1063529170

NPI Code Detail

MEDICARE: DR. ABHILASH R VAISHNAV MD

MEDICARE: DR. ABHILASH R VAISHNAV MD

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	207K00000X	Allergy & Immunology Physician	43816	MN
2	207K00000X	Allergy & Immunology Physician	48074	WI
3	207R00000X	Internal Medicine Physician	48074	WI
4	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	48074	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063529170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABHILASH R VAISHNAV MD

Provider Business Mailing Address
First Line	:	PO BOX 735044
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5044
Country	:	US
Telephone Number	:	800-326-2250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1881 CHICAGO ST
Second Line	:
City	:	DE PERE
State	:	WI
Zip	:	54115-3770
Country	:	US
Telephone Number	:	920-403-8000
Fax Number	:	920-403-8204

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	05/17/2024

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Directions to “ DR. ABHILASH R VAISHNAV MD” Practice Location

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