Provider Demographics
NPI:1922046358
Name:GADRINAB, NELCAR (MD)
Entity Type:Individual
Prefix:
First Name:NELCAR
Middle Name:
Last Name:GADRINAB
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 1:2315 E 93RD ST
Mailing Address - Street 2:SUITE 416
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3936
Mailing Address - Country:US
Mailing Address - Phone:773-768-5770
Mailing Address - Fax:773-768-0702
Practice Address - Street 1:2315 E 93RD ST
Practice Address - Street 2:SUITE 416
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3936
Practice Address - Country:US
Practice Address - Phone:773-768-5770
Practice Address - Fax:773-768-0702
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046459208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046459Medicaid
C14594Medicare UPIN