Healthcare Provider Details

I. General information

NPI: 1861810632
Provider Name (Legal Business Name): VIVEK PANDEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 OAKWOOD BLVD
DEARBORN MI
48124-2319
US

IV. Provider business mailing address

3815 HIGHLAND AVE
DOWNERS GROVE IL
60515-1500
US

V. Phone/Fax

Practice location:
  • Phone: 313-359-7600
  • Fax:
Mailing address:
  • Phone: 630-275-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125065462
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301516253
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.144547
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: