Provider Demographics
NPI:1619020039
Name:DIVYANG A JOSHI MD PC
Entity type:Organization
Organization Name:DIVYANG A JOSHI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIVYANG
Authorized Official - Middle Name:ANATRAY
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-931-8900
Mailing Address - Street 1:750 FLETCHER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4703
Mailing Address - Country:US
Mailing Address - Phone:847-931-8900
Mailing Address - Fax:847-931-9041
Practice Address - Street 1:750 FLETCHER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4703
Practice Address - Country:US
Practice Address - Phone:847-931-8900
Practice Address - Fax:847-931-9041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1626038OtherBLUE CROSS BLUE SHIELD
IL036082772Medicaid
ILF61155Medicare UPIN
IL036082772Medicaid