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NPI Code Detail

MEDICARE: AKHIL V JAGADEESH P.C.

MEDICARE: AKHIL V JAGADEESH P.C.
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
1122300000XDentistIL

General Provider Information

NPI Number : 1245402114
Entity Type Code : Organization
Provider Name (Legal Business Name) : AKHIL V JAGADEESH P.C.
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 :
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 :
Authorized Official
Title or Position : PRESIDENT
Name : DR. AKHIL V. JAGADEESH
Credential : DMD
Telephone Number : 773-348-3384
Provider Enumeration Date : 03/31/2008
Last Update Date : 03/31/2008

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