Provider Demographics
NPI:1497190359
Name:PANDIAN MEDICAL CORPORATION LTD
Entity Type:Organization
Organization Name:PANDIAN MEDICAL CORPORATION LTD
Other - Org Name:ADROITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-560-6015
Mailing Address - Street 1:120 E OGDEN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3542
Mailing Address - Country:US
Mailing Address - Phone:630-560-6015
Mailing Address - Fax:630-757-4140
Practice Address - Street 1:120 E OGDEN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3542
Practice Address - Country:US
Practice Address - Phone:630-560-6015
Practice Address - Fax:630-757-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
IL0361300362084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN260002881Medicare PIN