Provider Demographics
NPI:1528053568
Name:JOSHI, DIVYANG A (MD)
Entity type:Individual
Prefix:DR
First Name:DIVYANG
Middle Name:A
Last Name:JOSHI
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 1:750 FLETCHER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4703
Mailing Address - Country:US
Mailing Address - Phone:847-931-8900
Mailing Address - Fax:847-931-9041
Practice Address - Street 1:750 FLETCHER DR STE 200
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4703
Practice Address - Country:US
Practice Address - Phone:847-931-8900
Practice Address - Fax:847-931-9041
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082772Medicaid
IL1626038OtherBLUE CROSS BLUE SHIELD
ILF61155Medicare UPIN
IL036082772Medicaid