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NPI Code Detail

MEDICARE: DR. PAVAN YARLAGADDARAGHU PRASAD MD

MEDICARE:  DR. PAVAN YARLAGADDARAGHU PRASAD  MD
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
12084P0800XPsychiatry Physician125-060407IL

General Provider Information

NPI Number : 1659668440
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAVAN YARLAGADDARAGHU PRASAD MD
Provider Business Mailing Address
First Line : 1 E SUPERIOR ST
Second Line : SUITE 306
City : CHICAGO
State : IL
Zip : 60611-2507
Country : US
Telephone Number : 312-754-9404
Fax Number :
Provider Business Practice Location Address
First Line : 333 N MICHIGAN AVE STE 1400
Second Line :
City : CHICAGO
State : IL
Zip : 60601-4011
Country : US
Telephone Number : 312-815-9660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2011
Last Update Date : 07/01/2024

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Directions to “ DR. PAVAN YARLAGADDARAGHU PRASAD MD” Practice Location

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