Provider Demographics
NPI:1932224508
Name:NARENDRA H ANADKAT M D P C
Entity Type:Organization
Organization Name:NARENDRA H ANADKAT M D P C
Other - Org Name:WABASH PRIMARY CARE ASSOC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OFFICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARISSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-263-6280
Mailing Address - Street 1:1123 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-1212
Mailing Address - Country:US
Mailing Address - Phone:618-263-4376
Mailing Address - Fax:618-262-7970
Practice Address - Street 1:1123 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-1212
Practice Address - Country:US
Practice Address - Phone:618-263-4376
Practice Address - Fax:618-262-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215920756OtherINDIVIDUAL NPI
IL036061635Medicaid
216116Medicare PIN
ILC24762Medicare UPIN
IL036061635Medicaid