Provider Demographics
NPI:1689389835
Name:VOHRA, PAWAN K (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAWAN
Middle Name:K
Last Name:VOHRA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SPRING LAKE DR STE A
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-2070
Mailing Address - Country:US
Mailing Address - Phone:630-360-0269
Mailing Address - Fax:
Practice Address - Street 1:150 SPRING LAKE DR STE A
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-2070
Practice Address - Country:US
Practice Address - Phone:630-360-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246ZG1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZG1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGeneticist, Medical (PhD)