MEDICARE: ANIRUDDHA DEKA

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	2084P0800X	Psychiatry Physician	70228	CT
2	2084P0800X	Psychiatry Physician	125.072571	IL

General Provider Information

NPI Number	:	1689166027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANIRUDDHA DEKA

Provider Business Mailing Address
First Line	:	215 HARRISON ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60304-1533
Country	:	US
Telephone Number	:	708-628-8000
Fax Number	:	708-406-1503

Provider Business Practice Location Address
First Line	:	215 HARRISON ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60304-1533
Country	:	US
Telephone Number	:	708-628-8000
Fax Number	:	708-406-1503

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

Provider Enumeration Date	:	06/01/2018
Last Update Date	:	05/24/2024

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Directions to “ ANIRUDDHA DEKA ” Practice Location

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