Provider Demographics
NPI:1457432742
Name:PONAKALA, B NARAYAN (MD)
Entity Type:Individual
Prefix:
First Name:B
Middle Name:NARAYAN
Last Name:PONAKALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:409 W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1421
Mailing Address - Country:US
Mailing Address - Phone:630-964-9800
Mailing Address - Fax:888-598-6004
Practice Address - Street 1:7001 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2201
Practice Address - Country:US
Practice Address - Phone:773-229-8818
Practice Address - Fax:773-229-8423
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036092811207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G52472Medicare UPIN
IL260081Medicare PIN