Provider Demographics
NPI:1447305743
Name:PALONDIKAR, MAHABLESHWAR VASSANT (MD)
Entity type:Individual
Prefix:DR
First Name:MAHABLESHWAR
Middle Name:VASSANT
Last Name:PALONDIKAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2701 CRYSTAL WAY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-2226
Mailing Address - Country:US
Mailing Address - Phone:847-634-2333
Mailing Address - Fax:847-634-1132
Practice Address - Street 1:4160 RFD
Practice Address - Street 2:SUITE 306
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-9583
Practice Address - Country:US
Practice Address - Phone:847-634-2333
Practice Address - Fax:847-634-1132
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2020-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-051040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine