Healthcare Provider Details

I. General information

NPI: 1659465177
Provider Name (Legal Business Name): SUBHASH M. WAIKAR,MDSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 SAUK TRL
RICHTON PARK IL
60471-1167
US

IV. Provider business mailing address

4511 SAUK TRL
RICHTON PARK IL
60471-1167
US

V. Phone/Fax

Practice location:
  • Phone: 708-283-0300
  • Fax:
Mailing address:
  • Phone: 708-283-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SUBHASH M WAIKAR
Title or Position: OWNER
Credential:
Phone: 708-283-0300