Provider Demographics
NPI:1750374500
Name:TRIVEDI, DINKER A (MD)
Entity type:Individual
Prefix:DR
First Name:DINKER
Middle Name:A
Last Name:TRIVEDI
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 1:4950 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2504
Mailing Address - Country:US
Mailing Address - Phone:708-576-8150
Mailing Address - Fax:708-576-8831
Practice Address - Street 1:4950 W 95TH ST
Practice Address - Street 2:SUITE 409
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2504
Practice Address - Country:US
Practice Address - Phone:708-636-7575
Practice Address - Fax:708-636-5797
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-064527207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064527Medicaid
IL21622931OtherBCBS GROUP #
IL6742002OtherMEDICARE PTAN
IL060053847OtherPALMETTO GBA INDIVIDUAL #
ILCI8250OtherPALMETTO GBA GROUP #
ILA16640Medicare UPIN
IL036064527Medicaid
IL526200Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL6742002OtherMEDICARE PTAN