Provider Demographics
NPI:1154310449
Name:JOSHI, POONAM D (MD)
Entity Type:Individual
Prefix:DR
First Name:POONAM
Middle Name:D
Last Name:JOSHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:BROCK 4011
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-981-3694
Mailing Address - Fax:847-981-6508
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:BROCK 4011
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-981-3694
Practice Address - Fax:847-981-6508
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36111681207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36111681Medicaid
ILP00211760Medicare ID - Type UnspecifiedRAILROAD
IL36111681Medicaid
ILI16999Medicare UPIN