Provider Demographics
NPI:1134107170
Name:ANAND, DHARAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:DHARAM
Middle Name:R
Last Name:ANAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-0715
Mailing Address - Country:US
Mailing Address - Phone:815-932-9210
Mailing Address - Fax:815-932-9220
Practice Address - Street 1:100 PROVENA WAY STE D
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914
Practice Address - Country:US
Practice Address - Phone:815-932-9210
Practice Address - Fax:815-932-9220
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-076865207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076865Medicaid
IL4632036OtherBCBS
ILK02212Medicare ID - Type Unspecified