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General NPI Number Information
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NPI Number | 1639735608
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Entity Type | Organization
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Legal Business Name | TRIVEDIMD LLC
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 1605 S MICHIGAN AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60616-1209
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Country | US
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Telephone | 312-535-5770
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Fax |
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Provider Business Mailing Address
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Address Line | 16 N CARPENTER ST UNIT 4S
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City | CHICAGO
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State | IL
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Zip | 60607-2199
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Country | US
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Telephone | 630-533-4028
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANAN TRIVEDI
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Credential | MD
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Telephone | 630-533-4028
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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