Provider Demographics
NPI:1225183262
Name:KRISHNA V NADHAN M.D. S.C.
Entity Type:Organization
Organization Name:KRISHNA V NADHAN M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:V
Authorized Official - Last Name:NADHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-437-7575
Mailing Address - Street 1:1720 W ALGONQUIN RD
Mailing Address - Street 2:104
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-5400
Mailing Address - Country:US
Mailing Address - Phone:847-437-7575
Mailing Address - Fax:847-437-7589
Practice Address - Street 1:1720 W ALGONQUIN RD
Practice Address - Street 2:104
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-5400
Practice Address - Country:US
Practice Address - Phone:847-437-7575
Practice Address - Fax:847-437-7589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084273Medicaid
IL036084273Medicaid
ILBN3263427OtherDEA
ILE85621Medicare UPIN