Provider Demographics
NPI:1336373356
Name:PRAVEEN V PARVATHALA MD LLC
Entity Type:Organization
Organization Name:PRAVEEN V PARVATHALA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:PARVATHALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-691-0405
Mailing Address - Street 1:3555 SWEET MAGGIE LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8303
Mailing Address - Country:US
Mailing Address - Phone:630-904-6210
Mailing Address - Fax:630-952-1447
Practice Address - Street 1:3555 SWEET MAGGIE LN
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8303
Practice Address - Country:US
Practice Address - Phone:630-904-6210
Practice Address - Fax:630-952-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty