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General NPI Number Information
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NPI Number | 1609119932
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Entity Type | Individual
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Provider Name | ILYA M. KARAGODIN MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2013
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 9650 GROSS POINT RD STE 4900
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City | SKOKIE
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State | IL
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Zip | 60076-5080
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Country | US
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Telephone | 847-864-3278
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Fax | 847-676-1727
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Provider Business Mailing Address
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Address Line | 9650 GROSS POINT RD STE 4900
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City | SKOKIE
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State | IL
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Zip | 60076-5080
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Country | US
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Telephone | 847-864-3278
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Fax | 847-676-1727
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036142317
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License Number State | IL
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