Provider Demographics
NPI:1447206990
Name:PRAKASH G SANE MD SC
Entity Type:Organization
Organization Name:PRAKASH G SANE MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:SANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-799-2499
Mailing Address - Street 1:17680 KEDZIE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17680 KEDZIE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2043
Practice Address - Country:US
Practice Address - Phone:708-799-2499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00021603828OtherBCBS
IL216984Medicare UPIN
IL470520Medicare PIN
ILDG2491Medicare PIN