MEDICARE: DIVYA NADKARNI DESAI 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	2084E0001X	Epilepsy Physician	036.159485	IL
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	036.159485	IL

General Provider Information

NPI Number	:	1629335260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIVYA NADKARNI DESAI M.D.

Provider Business Mailing Address
First Line	:	225 E CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2991
Country	:	US
Telephone Number	:	312-227-3540
Fax Number	:	312-227-9644

Provider Business Practice Location Address
First Line	:	225 E CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2991
Country	:	US
Telephone Number	:	312-227-3540
Fax Number	:	312-227-9644

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

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	12/30/2024

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