1952306045 NPI number — DR. DINESH C PANDYA D.P.M.

Table of content: NADEJISA EDELWEISS OTANEZ (NPI 1194504753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952306045 NPI number — DR. DINESH C PANDYA D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANDYA
Provider First Name:
DINESH
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PANDYA
Provider Other First Name:
DINO
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1952306045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5695 STRATHMOOR DR
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61107-5192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-398-6400
Provider Business Mailing Address Fax Number:
815-398-6435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5695 STRATHMOOR DR
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61107-5192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-398-6400
Provider Business Practice Location Address Fax Number:
815-398-6435
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  01600-003233 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 601-01254 . This is a "BCBS, IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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