Provider Demographics
NPI:1174517114
Name:MADHANI, PARAG ARVIND (MD)
Entity type:Individual
Prefix:DR
First Name:PARAG
Middle Name:ARVIND
Last Name:MADHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3331 W DEYOUNG ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5896
Mailing Address - Country:US
Mailing Address - Phone:618-998-7600
Mailing Address - Fax:618-997-6680
Practice Address - Street 1:3331 W DEYOUNG ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5896
Practice Address - Country:US
Practice Address - Phone:618-998-7600
Practice Address - Fax:618-997-6680
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036092572207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092572Medicaid
IL036092572Medicaid
ILG43220Medicare UPIN