Individual
MADHAVI S DESHMUKH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2077 N CLYBOURN AVE, CHICAGO, IL 60614-4003
(773) 886-1500
Mailing address
2077 N CLYBOURN AVE, CHICAGO, IL 60614-4003
(773) 886-1500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
010759
NY
363A00000X
Physician Assistant
Primary
085002902
IL
363A00000X
Physician Assistant
PA180692
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA180692
MEDICAL LICENSE
OR
Enumeration date
01/05/2007
Last updated
12/04/2024
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