MEDICARE: DR. NISHAAN NAGARAKANTI DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036.151086	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	N26262088344	OTHER	IL	DRIVERS LISENCE

General Provider Information

NPI Number	:	1295264422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NISHAAN NAGARAKANTI DO

Provider Business Mailing Address
First Line	:	9715 WOODS DR UNIT 506
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-4440
Country	:	US
Telephone Number	:	630-697-3594
Fax Number	:

Provider Business Practice Location Address
First Line	:	9715 WOODS DR UNIT 506
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-4440
Country	:	US
Telephone Number	:	630-697-3594
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2017
Last Update Date	:	04/06/2026

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