Provider Demographics
NPI:1306995808
Name:DABHADE, NARENDRA D (MD)
Entity type:Individual
Prefix:
First Name:NARENDRA
Middle Name:D
Last Name:DABHADE
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 1:9722 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-3357
Mailing Address - Country:US
Mailing Address - Phone:847-455-3302
Mailing Address - Fax:847-455-2539
Practice Address - Street 1:9722 GRAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-3357
Practice Address - Country:US
Practice Address - Phone:847-455-3302
Practice Address - Fax:847-455-2539
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-041510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD11039Medicare UPIN