Basic Information
Provider Information
NPI: 1376170803
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANAND
FirstName: ROHIT
MiddleName: VASUDEV
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2160 S 1ST AVE
Address2:  
City: MAYWOOD
State: IL
PostalCode: 601533328
CountryCode: US
TelephoneNumber: 7082169000
FaxNumber: 7082160899
Practice Location
Address1: 2160 S 1ST AVE
Address2:  
City: MAYWOOD
State: IL
PostalCode: 601533328
CountryCode: US
TelephoneNumber: 7082169000
FaxNumber: 7082160899
Other Information
ProviderEnumerationDate: 03/25/2020
LastUpdateDate: 05/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
2085R0202X125.076208ILY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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