Healthcare Provider Details

I. General information

NPI: 1629335260
Provider Name (Legal Business Name): DIVYA NADKARNI DESAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIVYA SUNIL NADKARNI M.D.

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-3540
  • Fax: 312-227-9644
Mailing address:
  • Phone: 312-227-3540
  • Fax: 312-227-9644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036.159485
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number036.159485
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: