Provider Demographics
NPI:1689604969
Name:DOSI, PRABHA CHAND (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABHA
Middle Name:CHAND
Last Name:DOSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2112 TIMBER TRAIL
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-9388
Mailing Address - Country:US
Mailing Address - Phone:815-232-6822
Mailing Address - Fax:815-490-5906
Practice Address - Street 1:1401 E. STATE STREET
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104
Practice Address - Country:US
Practice Address - Phone:815-489-4177
Practice Address - Fax:815-490-5906
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360678242080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-067 824Medicaid
IL036-067 824Medicaid