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General NPI Number Information
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NPI Number | 1689166027
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Entity Type | Individual
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Provider Name | ANIRUDDHA DEKA
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Gender | Male
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 215 HARRISON ST
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City | OAK PARK
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State | IL
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Zip | 60304-1533
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Country | US
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Telephone | 708-628-8000
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Fax | 708-406-1503
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Provider Business Mailing Address
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Address Line | 215 HARRISON ST
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City | OAK PARK
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State | IL
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Zip | 60304-1533
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Country | US
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Telephone | 708-628-8000
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Fax | 708-406-1503
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 70228
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 125.072571
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License Number State | IL
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