Provider Demographics
NPI:1215987961
Name:UPADHYAY, SANJIV (MD)
Entity type:Individual
Prefix:DR
First Name:SANJIV
Middle Name:
Last Name:UPADHYAY
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 1:2040 OGDEN AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7208
Mailing Address - Country:US
Mailing Address - Phone:630-978-6895
Mailing Address - Fax:630-375-2905
Practice Address - Street 1:2040 OGDEN AVE STE 401
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7208
Practice Address - Country:US
Practice Address - Phone:630-978-6895
Practice Address - Fax:630-753-2905
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107658207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107658Medicaid
IL210373Medicare ID - Type Unspecified
ILG54749Medicare UPIN