Provider Demographics
NPI:1700832300
Name:SHINDE, ABHIJIT A (MD)
Entity Type:Individual
Prefix:
First Name:ABHIJIT
Middle Name:A
Last Name:SHINDE
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 1:1646 N BOSWORTH AVE
Mailing Address - Street 2:4S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2016
Mailing Address - Country:US
Mailing Address - Phone:773-227-5328
Mailing Address - Fax:
Practice Address - Street 1:1343 N FOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1422
Practice Address - Country:US
Practice Address - Phone:937-390-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085413207R00000X
KY38955207R00000X
IL36116671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2577304Medicaid
IL036116671-2Medicaid
01619414OtherBCBS
IL036116671-1Medicaid
01619414OtherBCBS
IL036116671-2Medicaid
216966009Medicare PIN