Provider Demographics
NPI:1295735124
Name:PAIDI, SASIKALA (MD)
Entity type:Individual
Prefix:PROF
First Name:SASIKALA
Middle Name:
Last Name:PAIDI
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 1:9301 GOLF RD
Mailing Address - Street 2:201
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1667
Mailing Address - Country:US
Mailing Address - Phone:847-803-5101
Mailing Address - Fax:847-803-5104
Practice Address - Street 1:9301 GOLF RD
Practice Address - Street 2:201
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1667
Practice Address - Country:US
Practice Address - Phone:847-803-5101
Practice Address - Fax:847-803-5104
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089172207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089172Medicaid
IL14D0996894OtherCLIA
ILBS4428024OtherD.E.A.
ILK12977Medicare UPIN
IL210531Medicare PIN