Provider Demographics
NPI:1003961343
Name:SUDHIR M GOKHALE MD SC
Entity Type:Organization
Organization Name:SUDHIR M GOKHALE MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOKHALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-636-2211
Mailing Address - Street 1:10735 S CICERO AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-6210
Mailing Address - Country:US
Mailing Address - Phone:708-636-2211
Mailing Address - Fax:708-636-5552
Practice Address - Street 1:10735 S CICERO AVE STE 100
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-6210
Practice Address - Country:US
Practice Address - Phone:708-636-2211
Practice Address - Fax:708-636-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058650101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058650Medicaid
ILK49731Medicare PIN
ILD13809Medicare UPIN
IL036058650Medicaid
ILK19566Medicare ID - Type Unspecified