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NPI Code Detail

MEDICARE: SUBHASH M WAIKAR MD

MEDICARE: SUBHASH M WAIKAR MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianIL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00439471/CK6882OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14673170001OTHERILDMERC

General Provider Information

NPI Number : 1154347045
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUBHASH M WAIKAR MD
Provider Business Mailing Address
First Line : 333 DIXIE HWY
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1748
Country : US
Telephone Number : 708-756-1000
Fax Number : 708-283-0379
Provider Business Practice Location Address
First Line : 333 DIXIE HWY
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1748
Country : US
Telephone Number : 708-756-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 02/08/2008

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