Provider Demographics
NPI:1659465177
Name:SUBHASH M. WAIKAR,MDSC
Entity Type:Organization
Organization Name:SUBHASH M. WAIKAR,MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBHASH
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAIKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-283-0300
Mailing Address - Street 1:4511 SAUK TRL
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-1167
Mailing Address - Country:US
Mailing Address - Phone:708-283-0300
Mailing Address - Fax:
Practice Address - Street 1:4511 SAUK TRL
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-1167
Practice Address - Country:US
Practice Address - Phone:708-283-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL916850Medicare ID - Type Unspecified
ILC42521Medicare UPIN