Healthcare Provider Details

I. General information

NPI: 1437466158
Provider Name (Legal Business Name): VISHAKHA NANDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST FOURTH FLOOR, NICU
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

1901 W HARRISON ST FOURTH FLOOR, NICU
CHICAGO IL
60612-3714
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-6000
  • Fax:
Mailing address:
  • Phone: 312-864-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-133399
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036-133399
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: