Provider Demographics
NPI:1427073352
Name:ADAVADKAR, PRANSHU A (MD)
Entity type:Individual
Prefix:
First Name:PRANSHU
Middle Name:A
Last Name:ADAVADKAR
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 1:840 S. WOOD STREET
Mailing Address - Street 2:M/C 856
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:414-324-9391
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST STE 2E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-996-7416
Practice Address - Fax:312-413-8778
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116217208000000X, 2080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34887200Medicaid
WI000601205Medicare PIN
WI34887200Medicaid