Provider Demographics
NPI:1376606491
Name:PATWARI, PALLAVI P (MD)
Entity Type:Individual
Prefix:DR
First Name:PALLAVI
Middle Name:P
Last Name:PATWARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PALLAVI
Other - Middle Name:P
Other - Last Name:PRASAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1620 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3801
Mailing Address - Country:US
Mailing Address - Phone:312-942-3034
Mailing Address - Fax:312-942-3193
Practice Address - Street 1:1620 W HARRISON ST
Practice Address - Street 2:SUITE 7 KELLOGG
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3801
Practice Address - Country:US
Practice Address - Phone:312-942-5046
Practice Address - Fax:312-942-2243
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361079002080P0203X
IL336.0688702080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine