Provider Demographics
NPI:1134342900
Name:SHIVDE, ASHOK VASANT (MD)
Entity type:Individual
Prefix:DR
First Name:ASHOK
Middle Name:VASANT
Last Name:SHIVDE
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 1:374 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-2547
Mailing Address - Country:US
Mailing Address - Phone:630-616-0638
Mailing Address - Fax:630-616-0638
Practice Address - Street 1:374 CRESTWOOD RD
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-2547
Practice Address - Country:US
Practice Address - Phone:630-616-0638
Practice Address - Fax:630-616-0638
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-058182207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology