Provider Demographics
NPI:1841489929
Name:DESHPANDE, BENALI GIRISH (MD)
Entity type:Individual
Prefix:DR
First Name:BENALI
Middle Name:GIRISH
Last Name:DESHPANDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:420 NE GLEN OAK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3105
Mailing Address - Country:US
Mailing Address - Phone:888-627-5673
Mailing Address - Fax:309-683-5969
Practice Address - Street 1:420 NE GLEN OAK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3105
Practice Address - Country:US
Practice Address - Phone:888-627-5673
Practice Address - Fax:309-683-5969
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-112326208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL809840OtherMEDICARE GROUP #
IL809840OtherMEDICARE GROUP #