MEDICARE: SOHAM VAISHNAV 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	208000000X	Pediatrics Physician	125051205	IL

General Provider Information

NPI Number	:	1477717825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOHAM VAISHNAV M.D.

Provider Business Mailing Address
First Line	:	540 N STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-7231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5721 S MARYLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1425
Country	:	US
Telephone Number	:	773-702-1000
Fax Number	:

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

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	07/15/2008

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