Organization Active NPI

Pinakinprasad Dave, MD, SC

  • Specialist
  • Calumet City, IL
National Provider Identifier
1659603868
Registry record updated Feb 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
036055316 Issued in IL
Legal business name
PINAKINPRASAD DAVE, MD, SC
Practice address
1851 Sibley Blvd
Calumet City, IL 60409-2252
Phone
(708) 868-2300
Fax
(708) 868-2304
NPI assigned
Feb 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Pinakinprasad Dave, M.D.
Title
President
Phone
(708) 895-6439

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 036055316 IL Primary

Addresses

Primary practice location

1851 Sibley Blvd
Calumet City, IL 60409-2252

Mailing address

1940 E 170TH PL
South Holland, IL 60473-3703
Phone (708) 895-6439

Other identifiers 1

IdentifierTypeStateIssuer
036055316MedicaidIL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265932800000",
    "number": "1659603868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 E 170TH PL",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604733703",
            "telephone_number": "708-895-6439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1851 SIBLEY BLVD",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "604092252",
            "telephone_number": "708-868-2300",
            "fax_number": "708-868-2304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINAKINPRASAD DAVE, MD, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-12",
        "last_updated": "2010-02-12",
        "status": "A",
        "authorized_official_last_name": "DAVE",
        "authorized_official_first_name": "PINAKINPRASAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-895-6439",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036055316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036055316",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Calumet City, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.