Provider Demographics
NPI:1760714703
Name:ASOKAN, VANITHA PUSHPA (MD)
Entity Type:Individual
Prefix:DR
First Name:VANITHA
Middle Name:PUSHPA
Last Name:ASOKAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:823 SARA CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-2900
Mailing Address - Country:US
Mailing Address - Phone:423-665-9272
Mailing Address - Fax:855-329-2725
Practice Address - Street 1:823 SARA CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-2900
Practice Address - Country:US
Practice Address - Phone:423-665-9272
Practice Address - Fax:855-329-2725
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-126486208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01188933OtherRR MEDICARE
IL036126486-2Medicaid
ILP01188933OtherRR MEDICARE