Basic Information
| Provider Information | |||||||||
| NPI: | 1548306533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAKODKAR | ||||||||
| FirstName: | SIDDHARTH | ||||||||
| MiddleName: | ARVIND | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2357 SEQUOIA DR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605066222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308596800 | ||||||||
| FaxNumber: | 6309073993 | ||||||||
| Practice Location | |||||||||
| Address1: | 2040 OGDEN AVE | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605047206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305857100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | LP00493 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | CLP00493 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0001X | 036-117908 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 036117908 | 05 | IL | MEDICAID |