Provider Demographics
NPI:1144273665
Name:PRASADARAO, PAUCHURU (MD)
Entity type:Individual
Prefix:
First Name:PAUCHURU
Middle Name:
Last Name:PRASADARAO
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 1:1412 JUSTIN CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8365
Mailing Address - Country:US
Mailing Address - Phone:630-420-2425
Mailing Address - Fax:773-296-7821
Practice Address - Street 1:765 ELA RD
Practice Address - Street 2:SUITE 305
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2337
Practice Address - Country:US
Practice Address - Phone:847-438-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC47513Medicare UPIN