Provider Demographics
NPI:1952306045
Name:PANDYA, DINESH C (DPM)
Entity Type:Individual
Prefix:DR
First Name:DINESH
Middle Name:C
Last Name:PANDYA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:DINO
Other - Middle Name:C
Other - Last Name:PANDYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:5695 STRATHMOOR DR
Mailing Address - Street 2:STE 1
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5192
Mailing Address - Country:US
Mailing Address - Phone:815-398-6400
Mailing Address - Fax:815-398-6435
Practice Address - Street 1:5695 STRATHMOOR DR
Practice Address - Street 2:STE 1
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5192
Practice Address - Country:US
Practice Address - Phone:815-398-6400
Practice Address - Fax:815-398-6435
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01600-003233213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL601-01254OtherBCBS, IL
ILT37807Medicare UPIN
IL683290Medicare ID - Type Unspecified