Healthcare Provider Details

I. General information

NPI: 1093804429
Provider Name (Legal Business Name): AJIT K. SACHDEVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH & ROOSEVELT RD EDWARD HINES JR. VA HOSPITAL
HINES IL
60141
US

IV. Provider business mailing address

633 N SAINT CLAIR ST AMERICAN COLLEGE OF SURGEONS, DIVISION OF EDUCATION
CHICAGO IL
60611-3234
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2036
  • Fax:
Mailing address:
  • Phone: 312-202-5405
  • Fax: 312-202-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: