Provider Demographics
NPI:1154401974
Name:DODIA, NARAN P (MD)
Entity type:Individual
Prefix:MR
First Name:NARAN
Middle Name:P
Last Name:DODIA
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 1:121 E CRESCENT
Mailing Address - Street 2:PO BOX 176
Mailing Address - City:GILMAN
Mailing Address - State:IL
Mailing Address - Zip Code:60938
Mailing Address - Country:US
Mailing Address - Phone:815-265-4628
Mailing Address - Fax:
Practice Address - Street 1:121 E CRESCENT
Practice Address - Street 2:
Practice Address - City:GILMAN
Practice Address - State:IL
Practice Address - Zip Code:60938
Practice Address - Country:US
Practice Address - Phone:815-265-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036065472Medicaid
14D0429417OtherCLIA
IL036065472Medicaid
694730Medicare ID - Type Unspecified