Healthcare Provider Details

I. General information

NPI: 1902288988
Provider Name (Legal Business Name): ANSHUL PANDEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S HIGHLAND AVE STE 130
LOMBARD IL
60148-4932
US

IV. Provider business mailing address

POB 7132960
CHICAGO IL
60677-0001
US

V. Phone/Fax

Practice location:
  • Phone: 630-627-4722
  • Fax: 630-627-9134
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-152297
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125.066573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: