Provider Demographics
NPI:1679570691
Name:KUDCHADKER, SHASHIKANT M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHASHIKANT
Middle Name:M
Last Name:KUDCHADKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W MARTIN AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6535
Mailing Address - Country:US
Mailing Address - Phone:630-357-1030
Mailing Address - Fax:630-357-8027
Practice Address - Street 1:10 W MARTIN AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6535
Practice Address - Country:US
Practice Address - Phone:630-357-1030
Practice Address - Fax:630-357-8027
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036040804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036040804Medicaid
IL036040804Medicaid