Provider Demographics
NPI:1073085379
Name:KAUSHIK, YASH
Entity Type:Individual
Prefix:
First Name:YASH
Middle Name:
Last Name:KAUSHIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19422 LISADELL DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-4473
Mailing Address - Country:US
Mailing Address - Phone:708-539-5200
Mailing Address - Fax:708-554-1980
Practice Address - Street 1:1251 E RICHTON RD
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-1623
Practice Address - Country:US
Practice Address - Phone:708-539-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700203082251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Single Specialty