Provider Demographics
NPI:1538282256
Name:PRADHAN, SUBARNA P (MD)
Entity Type:Individual
Prefix:
First Name:SUBARNA
Middle Name:P
Last Name:PRADHAN
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 1:9722 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-3357
Mailing Address - Country:US
Mailing Address - Phone:847-455-0110
Mailing Address - Fax:847-455-0199
Practice Address - Street 1:9722 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-3357
Practice Address - Country:US
Practice Address - Phone:847-455-0110
Practice Address - Fax:847-455-0199
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056560Medicaid