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General NPI Number Information
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NPI Number | 1174967822
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Entity Type | Individual
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Provider Name | AJAY DHARMAPPA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 10400 HALIGUS RD
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City | HUNTLEY
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State | IL
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Zip | 60142-9553
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Country | US
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Telephone | 224-654-0000
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Fax | 224-654-0000
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Provider Business Mailing Address
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Address Line | 5137 NW 109TH TER
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-2721
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Country | US
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Telephone | 954-629-5883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME128939
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036170120
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License Number State | IL
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