Provider Demographics
NPI:1467581801
Name:SONI, VINOD KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:KUMAR
Last Name:SONI
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 1:7530 W COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1196
Mailing Address - Country:US
Mailing Address - Phone:708-448-0016
Mailing Address - Fax:708-923-0705
Practice Address - Street 1:7530 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1196
Practice Address - Country:US
Practice Address - Phone:708-448-0016
Practice Address - Fax:708-923-0705
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-064178207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031620009OtherBLUE CROSS & BLUE SHIELD
686911Medicare ID - Type Unspecified
C67716Medicare UPIN