Provider Demographics
NPI:1649321183
Name:MOHAN, VENTRAPRAGADA S (MD)
Entity type:Individual
Prefix:DR
First Name:VENTRAPRAGADA
Middle Name:S
Last Name:MOHAN
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 1:340 W LINCOLN ST
Mailing Address - Street 2:300
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1900
Mailing Address - Country:US
Mailing Address - Phone:618-235-4883
Mailing Address - Fax:618-235-9573
Practice Address - Street 1:340 W LINCOLN ST STE 300
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1900
Practice Address - Country:US
Practice Address - Phone:618-235-4883
Practice Address - Fax:618-235-9573
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36056737207RC0200X, 207RS0012X, 207RP1001X
MO35338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOBLC21725OtherBLUE CHOICE OF MISSOURI
MO28568OtherANTHEM
IL4606572OtherAETNA
ILHEALTH PARTNERSOther300172
ILHEALTH ALLIANCEOther88170
IL371067092002OtherPRUDENTIAL
ILL013062OtherTRICARE
IL166028OtherHEALTHLINK
IL36056737Medicaid
IL4469353002OtherCIGNA
IL4809004OtherUNITED HEALTHCARE
ILCF6007OtherRAILROAD MEDICARE
IL08215136OtherFEDERAL BLUE CROSS
IL8215136OtherBC BS OF IL
ILHARMONYOther235930
ILP05919Medicare ID - Type Unspecified
IL36056737Medicaid
ILHARMONYOther235930