Provider Demographics
NPI:1205831393
Name:SINGH, PRITI (MD)
Entity Type:Individual
Prefix:DR
First Name:PRITI
Middle Name:
Last Name:SINGH
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 1:16W300 83RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5896
Mailing Address - Country:US
Mailing Address - Phone:630-230-3372
Mailing Address - Fax:630-568-5050
Practice Address - Street 1:16W300 83RD ST STE 100
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5896
Practice Address - Country:US
Practice Address - Phone:630-230-3372
Practice Address - Fax:630-568-5050
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2023-08-25
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
IL0360722992084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072299Medicaid
201680Medicare ID - Type Unspecified