Healthcare Provider Details

I. General information

NPI: 1659694396
Provider Name (Legal Business Name): NARENDRA D DABHADE MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9722 GRAND AVE SUITE 1
FRANKLIN PARK IL
60131-3357
US

IV. Provider business mailing address

9722 GRAND AVE SUITE 1
FRANKLIN PARK IL
60131-3357
US

V. Phone/Fax

Practice location:
  • Phone: 847-455-3302
  • Fax: 847-455-2539
Mailing address:
  • Phone: 847-455-3302
  • Fax: 847-455-2539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036041510
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036041510
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number036041510
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number036041510
License Number StateIL

VIII. Authorized Official

Name: NARENDRA D DABHADE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 847-455-3302