Basic Information
| Provider Information | |||||||||
| NPI: | 1336373356 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRAVEEN V PARVATHALA MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3555 SWEET MAGGIE LN | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605648303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309046210 | ||||||||
| FaxNumber: | 6309521447 | ||||||||
| Practice Location | |||||||||
| Address1: | 3555 SWEET MAGGIE LN | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605648303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309046210 | ||||||||
| FaxNumber: | 6309521447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2009 | ||||||||
| LastUpdateDate: | 10/16/2009 | ||||||||
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| AuthorizedOfficialLastName: | PARVATHALA | ||||||||
| AuthorizedOfficialFirstName: | PRAVEEN | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7086910405 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.