Healthcare Provider Details

I. General information

NPI: 1962841601
Provider Name (Legal Business Name): VIKASH SURESH HULIYAR DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2013
Last Update Date: 03/02/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 W MADISON ST STE 2
CHICAGO IL
60607-1822
US

IV. Provider business mailing address

1448 W MADISON ST STE 2
CHICAGO IL
60607-1822
US

V. Phone/Fax

Practice location:
  • Phone: 630-908-0120
  • Fax:
Mailing address:
  • Phone: 630-908-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019029440
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9279
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number021002978
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: