Provider Demographics
NPI:1073546776
Name:KAKODKAR, ARVIND (MD)
Entity Type:Individual
Prefix:
First Name:ARVIND
Middle Name:
Last Name:KAKODKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3297
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-8297
Mailing Address - Country:US
Mailing Address - Phone:219-924-8458
Mailing Address - Fax:
Practice Address - Street 1:3700 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-2224
Practice Address - Country:US
Practice Address - Phone:219-398-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029160A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100158590Medicaid
IN100158590Medicaid
IN458320Medicare PIN