Provider Demographics
NPI:1285670232
Name:KESHAVA, PRAMODE KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAMODE
Middle Name:KUMAR
Last Name:KESHAVA
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 1:9000 KILKENNY DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-8451
Mailing Address - Country:US
Mailing Address - Phone:773-768-5000
Mailing Address - Fax:773-768-6153
Practice Address - Street 1:9119 S EXCHANGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4225
Practice Address - Country:US
Practice Address - Phone:773-785-6800
Practice Address - Fax:773-785-9661
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094000173000000X
IL036.094000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094000Medicaid
IL036094000Medicaid