Healthcare Provider Details

I. General information

NPI: 1194288282
Provider Name (Legal Business Name): AVINESH AGARWALLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 W HIGGINS RD
SCHAUMBURG IL
60195-3203
US

IV. Provider business mailing address

929 W HIGGINS RD
SCHAUMBURG IL
60195-3203
US

V. Phone/Fax

Practice location:
  • Phone: 847-285-4200
  • Fax: 847-885-0130
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036179251
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number036179251
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA194041
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: