Provider Demographics
NPI:1972759298
Name:PANDYA, KEVIN K (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:K
Last Name:PANDYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:120 SPALDING DR STE 410
Practice Address - Street 2:NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6558
Practice Address - Country:US
Practice Address - Phone:630-369-0780
Practice Address - Fax:630-369-0886
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114970207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114970Medicaid
IL036114970Medicaid
IL575480015Medicare PIN
IL922820019Medicare PIN