Provider Demographics
NPI:1396908455
Name:NALLAPAREDDY, PRAVEEN (MD)
Entity type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:
Last Name:NALLAPAREDDY
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 1:701 SUPERIOR AVE
Mailing Address - Street 2:STE G
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4037
Mailing Address - Country:US
Mailing Address - Phone:219-922-3040
Mailing Address - Fax:219-922-3048
Practice Address - Street 1:4320 FIR ST UNIT 210
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-8410
Practice Address - Country:US
Practice Address - Phone:219-836-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.118276207RG0100X
IN01072083A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN105715OtherANTHEM
IL036118276Medicaid
IN628340OtherMEDICARE PTAN
IN100202290Medicaid
IL221956OtherIL MEDICAID PTAN