Provider Demographics
NPI:1700198249
Name:SUBARNA P PRADHAN M D S C
Entity Type:Organization
Organization Name:SUBARNA P PRADHAN M D S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SABARNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:PRADHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-455-0110
Mailing Address - Street 1:9722 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-3357
Mailing Address - Country:US
Mailing Address - Phone:847-455-0110
Mailing Address - Fax:847-455-0199
Practice Address - Street 1:9722 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-3357
Practice Address - Country:US
Practice Address - Phone:847-455-0110
Practice Address - Fax:847-455-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty