Active NPI
Dipankar Mukhopadhyay
- Pediatrics Physician
- La Grange, IL
National Provider Identifier
1659827186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036045296
- Practice address
- 5101 Willow Springs Rd
Family Practice Residency
La Grange, IL 60525-2600 - Phone
- (708) 245-8900
- Fax
- (708) 245-5615
- NPI assigned
- Aug 25, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036045296 | IL | Primary |
Addresses
Primary practice location
5101 Willow Springs Rd
Family Practice Residency
La Grange, IL 60525-2600
Mailing address
5101 Willow Springs Rd
Family Practice Residency
La Grange, IL 60525-2600
Phone (708) 245-8900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036045296 | IL | MD | Pediatrics Physician |
Interoperability endpoints
- dmukhopadhyay1240257@adventhealth.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472083200000",
"number": "1659827186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5101 WILLOW SPRINGS RD",
"address_2": "FAMILY PRACTICE RESIDENCY",
"city": "LA GRANGE",
"state": "IL",
"postal_code": "605252600",
"telephone_number": "708-245-8900",
"fax_number": "708-245-5615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5101 WILLOW SPRINGS RD",
"address_2": "FAMILY PRACTICE RESIDENCY",
"city": "LA GRANGE",
"state": "IL",
"postal_code": "605252600",
"telephone_number": "708-245-8900",
"fax_number": "708-245-5615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUKHOPADHYAY",
"first_name": "DIPANKAR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-08-25",
"last_updated": "2016-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036045296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Grange, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.