Provider Demographics
NPI:1679969000
Name:PRAVER, MOSHE ELIYAHU (MD)
Entity Type:Individual
Prefix:DR
First Name:MOSHE
Middle Name:ELIYAHU
Last Name:PRAVER
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 1:676 N ST. CLAIR AVENUE
Mailing Address - Street 2:SUITE 2210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-695-0086
Mailing Address - Fax:
Practice Address - Street 1:676 N ST. CLAIR AVENUE
Practice Address - Street 2:SUITE 2210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-695-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2016-05-10
Deactivation Date:2015-11-17
Deactivation Code:
Reactivation Date:2016-05-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program