Provider Demographics
NPI:1689639213
Name:ATTALURI, PRATAP (MD)
Entity Type:Individual
Prefix:
First Name:PRATAP
Middle Name:
Last Name:ATTALURI
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 1:3248 VANDEVER AVE
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554
Mailing Address - Country:US
Mailing Address - Phone:309-347-5522
Mailing Address - Fax:309-347-7302
Practice Address - Street 1:3248 VANDEVER AVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554
Practice Address - Country:US
Practice Address - Phone:309-347-5522
Practice Address - Fax:309-347-7302
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360849232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084923Medicaid
IL00303608492301OtherCONTROLLED SUBSTANCE
BA2768591OtherDEA LICENSE FEDERAL
IL036084923Medicaid
IL036084923Medicaid