MEDICARE: DAXA J JOSHI

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	376K00000X	Nurse's Aide
2	376K00000X	Nurse's Aide		IL

General Provider Information

NPI Number	:	1861047185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAXA J JOSHI

Provider Business Mailing Address
First Line	:	1762 ENGLISH DR
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-2429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1762 ENGLISH DR
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-2429
Country	:	US
Telephone Number	:	630-222-3392
Fax Number	:

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

Provider Enumeration Date	:	08/04/2019
Last Update Date	:	08/04/2019

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Directions to “ DAXA J JOSHI ” Practice Location

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