Provider Demographics
NPI:1326193541
Name:DONGRE, VINAYAK (MD)
Entity Type:Individual
Prefix:DR
First Name:VINAYAK
Middle Name:
Last Name:DONGRE
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 1:24600 W 127TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-9507
Mailing Address - Country:US
Mailing Address - Phone:815-731-9000
Mailing Address - Fax:815-731-9001
Practice Address - Street 1:24600 W 127TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9507
Practice Address - Country:US
Practice Address - Phone:815-731-9000
Practice Address - Fax:815-731-9001
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-101290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9933040OtherBCBS
IL9933040OtherBCBS