Provider Demographics
NPI:1326052309
Name:UPADHYAY, NARESH K (MD)
Entity Type:Individual
Prefix:
First Name:NARESH
Middle Name:K
Last Name:UPADHYAY
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 1:10547 MISTY HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-7439
Mailing Address - Country:US
Mailing Address - Phone:847-587-6112
Mailing Address - Fax:219-937-2195
Practice Address - Street 1:5500 S HOHMAN AVE STE 1E
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1962
Practice Address - Country:US
Practice Address - Phone:219-852-0197
Practice Address - Fax:219-937-2195
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039671A207RC0200X, 207RS0012X, 207RP1001X
IL036083179207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200066830AMedicaid
IL036083179Medicaid
ILK36165Medicare PIN
IN200066830AMedicaid
IN253270AOtherMEDICARE INDIVIDUAL PIN
ILE19167Medicare UPIN
ING01623Medicare UPIN
IL036083179Medicaid
IN000095707OtherBCBS ANTHEM