Provider Demographics
NPI:1134288483
Name:GARLA, PRABHAKAR GUPTA NARASIMHAIAH
Entity Type:Individual
Prefix:DR
First Name:PRABHAKAR GUPTA
Middle Name:NARASIMHAIAH
Last Name:GARLA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:PRABHAKAR GUPTA
Other - Middle Name:NARASIMHAIAH
Other - Last Name:GARLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:74 DUNDEE LANE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5106
Mailing Address - Country:US
Mailing Address - Phone:847-842-1636
Mailing Address - Fax:206-666-7345
Practice Address - Street 1:74 DUNDEE LANE
Practice Address - Street 2:
Practice Address - City:BARRINGTON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60010-5106
Practice Address - Country:US
Practice Address - Phone:847-842-1636
Practice Address - Fax:206-666-7345
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13889Medicare UPIN