Provider Demographics
NPI:1245496850
Name:PODJASEK, JOSHUA O (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:O
Last Name:PODJASEK
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 1:8110 S CASS AVE
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5013
Mailing Address - Country:US
Mailing Address - Phone:630-920-1900
Mailing Address - Fax:630-920-1901
Practice Address - Street 1:8110 S CASS AVE
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5013
Practice Address - Country:US
Practice Address - Phone:630-920-1900
Practice Address - Fax:630-920-1901
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.054490207R00000X
MN104541207N00000X
MN52332207N00000X
IL036.133122207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MN070000845Medicare PIN