Provider Demographics
NPI:1235123308
Name:UPADHYAY, NANDINI (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDINI
Middle Name:
Last Name:UPADHYAY
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 1:15 TOWER CT
Mailing Address - Street 2:STE 100
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3336
Mailing Address - Country:US
Mailing Address - Phone:847-244-1375
Mailing Address - Fax:847-244-1002
Practice Address - Street 1:15 TOWER CT
Practice Address - Street 2:STE 100
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3336
Practice Address - Country:US
Practice Address - Phone:847-244-1375
Practice Address - Fax:847-244-1002
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072633208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360372633Medicaid
IL0360372633Medicaid