Healthcare Provider Details

I. General information

NPI: 1336136258
Provider Name (Legal Business Name): PANKAJ G VASHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 01/07/2024
Certification Date: 01/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 ELISHA AVE
ZION IL
60099-2676
US

IV. Provider business mailing address

2520 ELISHA AVE
ZION IL
60099
US

V. Phone/Fax

Practice location:
  • Phone: 847-872-6415
  • Fax: 847-746-6007
Mailing address:
  • Phone: 847-872-4561
  • Fax: 847-263-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036-083762
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036.083762
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: