Provider Demographics
NPI:1548306533
Name:KAKODKAR, SIDDHARTH ARVIND (MD)
Entity type:Individual
Prefix:DR
First Name:SIDDHARTH
Middle Name:ARVIND
Last Name:KAKODKAR
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 1:2357 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6222
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:630-907-3993
Practice Address - Street 1:2040 OGDEN AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7206
Practice Address - Country:US
Practice Address - Phone:630-585-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP00493207R00000X
RICLP00493207R00000X
IL036-117908207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117908Medicaid
IL036117908Medicaid