Provider Demographics
NPI:1639182678
Name:GOKHALE, SUDHIR MADHUKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:MADHUKAR
Last Name:GOKHALE
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 1:10735 S CICERO AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-6210
Mailing Address - Country:US
Mailing Address - Phone:708-636-2211
Mailing Address - Fax:708-636-5552
Practice Address - Street 1:10735 S CICERO AVE STE 100
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-6210
Practice Address - Country:US
Practice Address - Phone:708-636-2211
Practice Address - Fax:708-636-5552
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360586502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13809Medicare UPIN