Healthcare Provider Details

I. General information

NPI: 1407923139
Provider Name (Legal Business Name): UDAY S TALWALKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 S CICERO AVE
OAK FOREST IL
60452
US

IV. Provider business mailing address

15900 S CICERO AVE
OAK FOREST IL
60452
US

V. Phone/Fax

Practice location:
  • Phone: 708-633-3487
  • Fax: 708-633-3449
Mailing address:
  • Phone: 708-633-3487
  • Fax: 708-633-3449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36077921
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: