Provider Demographics
NPI:1710997556
Name:PRASANNA S NAIR MDSC
Entity Type:Organization
Organization Name:PRASANNA S NAIR MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRASANNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-293-0922
Mailing Address - Street 1:5140 N CALLIFORNIA AVE
Mailing Address - Street 2:540
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-293-0922
Mailing Address - Fax:773-293-0928
Practice Address - Street 1:5140 N CALLIFORNIA AVE
Practice Address - Street 2:540
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-293-0922
Practice Address - Fax:773-293-0928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
200169Medicare ID - Type Unspecified
G59636Medicare UPIN