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General NPI Number Information
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NPI Number | 1962567651
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Entity Type | Organization
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Legal Business Name | AJAY A MADHANI MD SC
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Dates
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Enumeration Date | 12/25/2006
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Last Update Date | 12/31/2021
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Provider Practice Location Address
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Address Line | 755 S MILWAUKEE AVE SUITE 263
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3253
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Country | US
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Telephone | 847-367-0787
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Fax |
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Provider Business Mailing Address
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Address Line | 200 SOUTHFIELD DR
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City | VERNON HILLS
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State | IL
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Zip | 60061-3209
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Country | US
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Telephone | 847-642-3781
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AJAY A MADHANI
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Credential | MD
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Telephone | 847-642-3781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 042 007596
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License Number State | IL
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