Provider Demographics
NPI:1194934554
Name:ARGHAVANI, TRACY S (DO)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:S
Last Name:ARGHAVANI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 HALIGUS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9526
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:847-802-7201
Practice Address - Street 1:10350 HALIGUS RD STE 120
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:847-802-7201
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016123207V00000X
KY03518207V00000X
NMA-1465-08207V00000X
IL036141030207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036141030OtherSTATE LICENSE
KY7100219480Medicaid
KY7100219480Medicaid