Provider Demographics
NPI: | 1669460879 |
---|---|
Name: | RATTAN, PRADEEP (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | PRADEEP |
Middle Name: | |
Last Name: | RATTAN |
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: | 3537 PAYSPHERE CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60674-0035 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 708-786-2900 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1501 S CALIFORNIA AVE |
Practice Address - Street 2: | |
Practice Address - City: | CHICAGO |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60608-1732 |
Practice Address - Country: | US |
Practice Address - Phone: | 773-257-6672 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Not Answered |
Enumeration Date: | 2005-10-11 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 2084P0800X, 2084P0805X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Not Answered | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | 036-055658-5 | Medicaid | |
IL | D14343 | Medicare UPIN | |
IL | 036-055658-5 | Medicaid |