Provider Demographics
NPI:1669531208
Name:HARIDAS, PANKAJ J (MD)
Entity type:Individual
Prefix:
First Name:PANKAJ
Middle Name:J
Last Name:HARIDAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-0443
Mailing Address - Country:US
Mailing Address - Phone:708-831-8282
Mailing Address - Fax:773-714-1229
Practice Address - Street 1:8420 W BRYN MAWR AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3436
Practice Address - Country:US
Practice Address - Phone:708-831-8282
Practice Address - Fax:773-714-1229
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036097116207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology