Provider Demographics
NPI:1124035944
Name:ACHARYA, VASANT R (MD)
Entity Type:Individual
Prefix:
First Name:VASANT
Middle Name:R
Last Name:ACHARYA
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 1:932 LAKE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1204
Mailing Address - Country:US
Mailing Address - Phone:331-221-1700
Mailing Address - Fax:331-221-2729
Practice Address - Street 1:932 LAKE ST STE 300
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1204
Practice Address - Country:US
Practice Address - Phone:331-221-1700
Practice Address - Fax:331-221-2729
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050860207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050860Medicaid
ILP00260047OtherMEDICARE RAILROAD
ILP00260047OtherMEDICARE RAILROAD
ILK18201Medicare ID - Type Unspecified