Provider Demographics
NPI:1538157045
Name:SAWLANI, HARESH B (MD)
Entity type:Individual
Prefix:DR
First Name:HARESH
Middle Name:B
Last Name:SAWLANI
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 1:3445 N CENTRAL AVE # C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4420
Mailing Address - Country:US
Mailing Address - Phone:773-205-0800
Mailing Address - Fax:773-205-1804
Practice Address - Street 1:3445 N CENTRAL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4420
Practice Address - Country:US
Practice Address - Phone:773-205-0800
Practice Address - Fax:773-205-1804
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091782Medicaid
G 65094Medicare UPIN