Provider Demographics
NPI:1982623575
Name:PAUL, UDAY K (MD)
Entity Type:Individual
Prefix:
First Name:UDAY
Middle Name:K
Last Name:PAUL
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 1:2723 SHERIDAN RD STE C
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-2616
Mailing Address - Country:US
Mailing Address - Phone:847-360-4260
Mailing Address - Fax:
Practice Address - Street 1:2723 SHERIDAN RD STE C
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-2616
Practice Address - Country:US
Practice Address - Phone:847-360-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068288A207R00000X, 208M00000X
IL036107590208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400339458OtherMEDICARE IL
ININ1933017Medicare PIN
IN200991690Medicaid