Provider Demographics
NPI:1093700072
Name:KONERU, PRAFULLA K (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAFULLA
Middle Name:K
Last Name:KONERU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EXECUTIVE COURT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010
Mailing Address - Country:US
Mailing Address - Phone:847-382-8200
Mailing Address - Fax:847-382-8210
Practice Address - Street 1:5 EXECUTIVE COURT
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010
Practice Address - Country:US
Practice Address - Phone:847-382-8200
Practice Address - Fax:847-382-8210
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052132174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052132Medicaid
ILC49242Medicare UPIN
IL498251Medicare ID - Type Unspecified