MEDICARE: NORTHEAST ENDOCRINOLOGY

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	174400000X	Specialist		IL

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	:	1558576843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST ENDOCRINOLOGY

Provider Business Mailing Address
First Line	:	2222 WEBER RD.
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 WEBER RD
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60435-0928
Country	:	US
Telephone Number	:	815-741-9714
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	VEENA NADKARNI
Credential	:	M.D.
Telephone Number	:	815-741-9714

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	08/22/2020

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