Healthcare Provider Details

I. General information

NPI: 1386801751
Provider Name (Legal Business Name): NAVEEN DIVAKARUNI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N HIGHLAND AVE OFC 1
AURORA IL
60506-1404
US

IV. Provider business mailing address

28594 NETWORK PL
CHICAGO IL
60673-1285
US

V. Phone/Fax

Practice location:
  • Phone: 630-554-3456
  • Fax: 630-551-2970
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number125.052467
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036-132214
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: