MEDICARE: DR. ANISH PRAVIN PITHADIA M.D.

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
1	207Q00000X	Family Medicine Physician	036-116564	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619414	OTHER	IL	BCBS GRP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417074774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANISH PRAVIN PITHADIA M.D.

Provider Business Mailing Address
First Line	:	3633 W LAKE AVE STE 108
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5801
Country	:	US
Telephone Number	:	847-510-2805
Fax Number	:	847-510-2806

Provider Business Practice Location Address
First Line	:	3633 W LAKE AVE STE 108
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5801
Country	:	US
Telephone Number	:	847-510-2805
Fax Number	:	847-510-2806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	11/14/2022

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