Provider Demographics
NPI:1245491034
Name:PITRODA, TANYA (MD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:PITRODA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S WASHINGTON ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7430
Mailing Address - Country:US
Mailing Address - Phone:630-527-5359
Mailing Address - Fax:630-527-5526
Practice Address - Street 1:801 S WASHINGTON ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7430
Practice Address - Country:US
Practice Address - Phone:630-527-5359
Practice Address - Fax:630-527-5526
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125050430207R00000X
IL036121301208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036121301 1Medicaid
IL2220936OtherBCBS
ILP00654892Medicare PIN
ILK52328Medicare PIN