Provider Demographics
NPI:1003993569
Name:NAVNI, PRAKASH CHAND (DPT)
Entity Type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:CHAND
Last Name:NAVNI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:MR
Other - First Name:PRAKASH
Other - Middle Name:CHAND
Other - Last Name:NAVNI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:31 PINE NEEDLES DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-7741
Mailing Address - Country:US
Mailing Address - Phone:630-243-7023
Mailing Address - Fax:708-393-4681
Practice Address - Street 1:3900 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:STICKNEY
Practice Address - State:IL
Practice Address - Zip Code:60402-4168
Practice Address - Country:US
Practice Address - Phone:708-484-7543
Practice Address - Fax:708-393-4681
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
IL225100000X, 376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK12693Medicare ID - Type Unspecified