Provider Demographics
NPI:1538134960
Name:AGARWAL, NARESH KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:NARESH
Middle Name:KUMAR
Last Name:AGARWAL
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 1:8600 NORTH ROUTE 91
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615
Mailing Address - Country:US
Mailing Address - Phone:309-683-5050
Mailing Address - Fax:309-683-5335
Practice Address - Street 1:8600 NORTH ROUTE 91
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615
Practice Address - Country:US
Practice Address - Phone:309-683-5050
Practice Address - Fax:309-683-5335
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL03693491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00618660OtherRR MEDICARE GROUP MEMBER PTAN
IL036093491Medicaid
IL809840OtherMEDICARE GROUP PTAN
ILCA4079OtherRR MEDICARE GROUP PTAN
IL809840OtherMEDICARE GROUP PTAN