Provider Demographics
NPI:1033406566
Name:TRIVEDI, KOVID (MBBS)
Entity Type:Individual
Prefix:DR
First Name:KOVID
Middle Name:
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 SHARK CT APT C
Mailing Address - Street 2:NIMITZ VILLAGE
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-1142
Mailing Address - Country:US
Mailing Address - Phone:610-969-8250
Mailing Address - Fax:
Practice Address - Street 1:3333 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3037
Practice Address - Country:US
Practice Address - Phone:847-578-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine