Provider Demographics
NPI:1215416292
Name:MDPROACTIVE.COM,LLC
Entity Type:Organization
Organization Name:MDPROACTIVE.COM,LLC
Other - Org Name:WEBDOCTORS.COM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NARENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-369-6644
Mailing Address - Street 1:1995 SPRINGBROOK SQUARE DR STE 119
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5953
Mailing Address - Country:US
Mailing Address - Phone:630-369-6644
Mailing Address - Fax:630-369-3428
Practice Address - Street 1:1995 SPRINGBROOK SQUARE DR STE 119
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5953
Practice Address - Country:US
Practice Address - Phone:630-369-6644
Practice Address - Fax:630-369-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-069044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty