Provider Demographics
NPI:1437113461
Name:VOHRA, PRAVEEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:
Last Name:VOHRA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 678
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-0678
Mailing Address - Country:US
Mailing Address - Phone:815-254-3338
Mailing Address - Fax:815-436-8367
Practice Address - Street 1:24039 W LOCKPORT ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-1652
Practice Address - Country:US
Practice Address - Phone:815-254-3338
Practice Address - Fax:815-436-8367
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004798213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09908116OtherBLUE CROSS BLUE SHIELD
ILU59328Medicare UPIN
IL245080Medicare PIN
IL1292920001Medicare NSC