MEDICARE: MRS. USHA R VAKHARIA MD

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	208D00000X	General Practice Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001635951	OTHER		BLUE CROSS ELECTRONIC

General Provider Information

NPI Number	:	1821133430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. USHA R VAKHARIA MD

Provider Business Mailing Address
First Line	:	2601 GREENWOOD RD
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-7622
Country	:	US
Telephone Number	:	847-564-5255
Fax Number	:	847-564-5255

Provider Business Practice Location Address
First Line	:	26TH STREET MEDICAL SERVICE COOP SC 3814 W 26TH STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623
Country	:	US
Telephone Number	:	773-522-5200
Fax Number	:	773-522-5356

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	03/07/2023

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