Healthcare Provider Details

I. General information

NPI: 1427073352
Provider Name (Legal Business Name): PRANSHU A ADAVADKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST STE 2E
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

840 S. WOOD STREET M/C 856
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7416
  • Fax: 312-413-8778
Mailing address:
  • Phone: 414-324-9391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036116217
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number036116217
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: