Provider Demographics
NPI:1821133430
Name:VAKHARIA, USHA R (MD)
Entity Type:Individual
Prefix:MRS
First Name:USHA
Middle Name:R
Last Name:VAKHARIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2601 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7622
Mailing Address - Country:US
Mailing Address - Phone:847-564-5255
Mailing Address - Fax:847-564-5255
Practice Address - Street 1:26TH STREET MEDICAL SERVICE COOP SC 3814 W 26TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623
Practice Address - Country:US
Practice Address - Phone:773-522-5200
Practice Address - Fax:773-522-5356
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001635951OtherBLUE CROSS ELECTRONIC
0001635951OtherBLUE CROSS ELECTRONIC
ILB2848024OtherDEA
C41883Medicare UPIN