Provider Demographics
NPI:1073724076
Name:KAKODKAR, KEDAR ARVIND (MD)
Entity Type:Individual
Prefix:
First Name:KEDAR
Middle Name:ARVIND
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 1:1950 45TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3958
Mailing Address - Country:US
Mailing Address - Phone:219-703-9393
Mailing Address - Fax:219-703-6763
Practice Address - Street 1:1950 45TH ST STE 100
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3958
Practice Address - Country:US
Practice Address - Phone:219-703-9393
Practice Address - Fax:219-703-6763
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.053464207Y00000X
IN01074176A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology