Provider Demographics
NPI:1790844181
Name:DHINDSA, AVTAR S (MD)
Entity Type:Individual
Prefix:
First Name:AVTAR
Middle Name:S
Last Name:DHINDSA
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 1:4309 W MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8419
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:
Practice Address - Street 1:4309 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8419
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60798311208800000X
IL036076432208800000X
IN01041877208800000X
IN01041877A208800000X
WV26606208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100209960AMedicaid
IN100209960Medicaid
IL036076432Medicaid
IL036076432Medicaid
ILF46863Medicare UPIN
IN100209960Medicaid
IL399980Medicare PIN
F46863Medicare UPIN
ILK35013Medicare ID - Type Unspecified