Healthcare Provider Details

I. General information

NPI: 1982901211
Provider Name (Legal Business Name): NORTHEAST ENDOCRINOLOGY CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 WEBER RD
CREST HILL IL
60403-0928
US

IV. Provider business mailing address

2222 WEBER RD
CREST HILL IL
60403-0928
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-9714
  • Fax: 815-744-5137
Mailing address:
  • Phone: 815-741-9714
  • Fax: 815-744-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036097180
License Number StateIL

VIII. Authorized Official

Name: VEENA NADKARNI
Title or Position: DIRECTOR
Credential:
Phone: 815-741-9714