Provider Demographics
NPI:1467535740
Name:NARAYAN, MUKUND (MD)
Entity Type:Individual
Prefix:
First Name:MUKUND
Middle Name:
Last Name:NARAYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4940
Mailing Address - Country:US
Mailing Address - Phone:773-278-1880
Mailing Address - Fax:773-278-0060
Practice Address - Street 1:3202 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4940
Practice Address - Country:US
Practice Address - Phone:773-278-1880
Practice Address - Fax:773-278-0060
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-096432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G46226Medicare UPIN
367830Medicare PIN