Provider Demographics
NPI:1013032499
Name:CHAPPIDI, PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:
Last Name:CHAPPIDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 320
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-0320
Mailing Address - Country:US
Mailing Address - Phone:773-205-9800
Mailing Address - Fax:773-205-9801
Practice Address - Street 1:5600 W. ADDISON
Practice Address - Street 2:STE 206
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634
Practice Address - Country:US
Practice Address - Phone:773-205-9800
Practice Address - Fax:773-205-9801
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360976602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097660Medicaid
IL036097660Medicaid