Provider Demographics
NPI:1841271947
Name:MADHANI, AJAY A (MD)
Entity type:Individual
Prefix:DR
First Name:AJAY
Middle Name:A
Last Name:MADHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 SOUTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3209
Mailing Address - Country:US
Mailing Address - Phone:847-816-6935
Mailing Address - Fax:847-816-6945
Practice Address - Street 1:985 S BUFFALO GROVE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3702
Practice Address - Country:US
Practice Address - Phone:847-541-4878
Practice Address - Fax:847-520-0500
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-087144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL087144Medicaid
ILF69780Medicare UPIN
IL087144Medicaid