Provider Demographics
NPI:1992907893
Name:TANEJA, AASHISH (MD)
Entity type:Individual
Prefix:DR
First Name:AASHISH
Middle Name:
Last Name:TANEJA
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 1:7402 E RIVERSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-5630
Mailing Address - Country:US
Mailing Address - Phone:815-971-3920
Mailing Address - Fax:815-226-9672
Practice Address - Street 1:7402 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-5630
Practice Address - Country:US
Practice Address - Phone:815-971-3920
Practice Address - Fax:815-226-9672
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086698207ND0900X, 207N00000X, 207NS0135X
IL036122049207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992907893Medicaid