Provider Demographics
NPI:1508880287
Name:DWARAKANATHAN, ARCOT (MD,FACE)
Entity Type:Individual
Prefix:
First Name:ARCOT
Middle Name:
Last Name:DWARAKANATHAN
Suffix:
Gender:M
Credentials:MD,FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:317-528-4253
Mailing Address - Fax:317-865-8319
Practice Address - Street 1:20201 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1010
Practice Address - Country:US
Practice Address - Phone:708-679-2130
Practice Address - Fax:708-679-2260
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-046124174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046124Medicaid
IL1619159OtherBLUE CROSS BLUE SHIELDS
IL460000530OtherRR MEDICARE
IL5686019OtherMEDICARE PTAN
IL036046124Medicaid