Healthcare Provider Details

I. General information

NPI: 1841262961
Provider Name (Legal Business Name): NITIN NADKARNI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 WEBER RD
CREST HILL IL
60435-0928
US

IV. Provider business mailing address

2222 WEBER RD
CREST HILL IL
60435-0928
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-9719
  • Fax: 815-744-5137
Mailing address:
  • Phone: 815-741-9719
  • Fax: 815-744-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number36097009
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: