Provider Demographics
NPI:1063864734
Name:PAREKH, PREYANSHU M (DO)
Entity Type:Individual
Prefix:
First Name:PREYANSHU
Middle Name:M
Last Name:PAREKH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 STATION DR STE 300A
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7978
Mailing Address - Country:US
Mailing Address - Phone:815-788-7500
Mailing Address - Fax:815-455-8044
Practice Address - Street 1:360 STATION DR STE 300A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7978
Practice Address - Country:US
Practice Address - Phone:815-788-7500
Practice Address - Fax:815-455-8044
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036150563207P00000X, 207Q00000X
WI88-321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036150563OtherSTATE LICENSE
WI1063864734Medicaid