Provider Demographics
NPI:1619293800
Name:TRIVEDI, ABHAYA PANDIT
Entity Type:Individual
Prefix:
First Name:ABHAYA
Middle Name:PANDIT
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABHAYA
Other - Middle Name:ARKESH
Other - Last Name:PANDIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 E OHIO ST
Mailing Address - Street 2:APT 8D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3390
Mailing Address - Country:US
Mailing Address - Phone:248-470-3421
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.143182207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine