Provider Demographics
NPI:1205016086
Name:PRIME HEALTH ASSOCIATES INC
Entity Type:Organization
Organization Name:PRIME HEALTH ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LATA
Authorized Official - Middle Name:JOYTI
Authorized Official - Last Name:NAGPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-961-2011
Mailing Address - Street 1:519 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-3128
Mailing Address - Country:US
Mailing Address - Phone:630-961-2011
Mailing Address - Fax:630-961-2067
Practice Address - Street 1:519 W 87TH ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-3128
Practice Address - Country:US
Practice Address - Phone:630-961-2011
Practice Address - Fax:630-961-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK21592Medicare UPIN