Provider Demographics
NPI:1801102678
Name:TRIVEDI, PRATIKSHA (MD)
Entity type:Individual
Prefix:DR
First Name:PRATIKSHA
Middle Name:
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1751 S NAPERVILLE RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5896
Mailing Address - Country:US
Mailing Address - Phone:630-221-0200
Mailing Address - Fax:630-384-2240
Practice Address - Street 1:1751 S NAPERVILLE RD
Practice Address - Street 2:STE 107
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5896
Practice Address - Country:US
Practice Address - Phone:630-682-9700
Practice Address - Fax:630-682-3771
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.129354207LP2900X
IL036-129354208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036129354Medicaid