Healthcare Provider Details

I. General information

NPI: 1902383706
Provider Name (Legal Business Name): ISHA PARIKH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N MADISON ST
WOODSTOCK IL
60098-3450
US

IV. Provider business mailing address

3 WARWICK CT
STREAMWOOD IL
60107-1926
US

V. Phone/Fax

Practice location:
  • Phone: 815-338-7569
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019031750
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: