Provider Demographics
NPI:1578542304
Name:PARIKH, YOGIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:YOGIN
Middle Name:J
Last Name:PARIKH
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 1:4 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9148
Mailing Address - Country:US
Mailing Address - Phone:309-234-5873
Mailing Address - Fax:
Practice Address - Street 1:4 SAWGRASS DR
Practice Address - Street 2:
Practice Address - City:COAL VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61240-9148
Practice Address - Country:US
Practice Address - Phone:309-234-5873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2013-12-17
Deactivation Date:2012-12-13
Deactivation Code:
Reactivation Date:2013-11-07
Provider Licenses
StateLicense IDTaxonomies
IL036080225174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036080225Medicaid
ILE64622Medicare UPIN
IL036080225Medicaid