Provider Demographics
NPI:1457348187
Name:PHADKE, ASHOK B (MD)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:B
Last Name:PHADKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2031 E GRAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-9041
Mailing Address - Country:US
Mailing Address - Phone:847-356-5575
Mailing Address - Fax:847-356-1792
Practice Address - Street 1:2031 E GRAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-9041
Practice Address - Country:US
Practice Address - Phone:847-356-5575
Practice Address - Fax:847-356-1792
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2009-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL36-093977208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G56083Medicare UPIN