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NPI Code Detail

MEDICARE: DR. AKHIL VENKATESH JAGADEESH DMD

MEDICARE: DR. AKHIL VENKATESH JAGADEESH DMD
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
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1245317908
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AKHIL VENKATESH JAGADEESH DMD
Provider Business Mailing Address
First Line : 2674 N HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-2361
Country : US
Telephone Number : 773-348-3384
Fax Number : 773-348-5564
Provider Business Practice Location Address
First Line : 2674 N HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-2361
Country : US
Telephone Number : 773-348-3384
Fax Number : 773-348-5564
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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