Provider Demographics
NPI:1437261963
Name:NAG, PRATIP KUMAR (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:PRATIP
Middle Name:KUMAR
Last Name:NAG
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 WATERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3715
Mailing Address - Country:US
Mailing Address - Phone:815-994-8916
Mailing Address - Fax:
Practice Address - Street 1:144 NORTH CT
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-1224
Practice Address - Country:US
Practice Address - Phone:815-285-5437
Practice Address - Fax:815-285-8928
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-133213208000000X
TXM4388208000000X
GA96532208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036133213Medicaid