Healthcare Provider Details

I. General information

NPI: 1134250582
Provider Name (Legal Business Name): NAGESWARA R NAGARAKANTI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MERCY LN
AURORA IL
60506-2447
US

IV. Provider business mailing address

400 MERCY LN
AURORA IL
60506
US

V. Phone/Fax

Practice location:
  • Phone: 630-966-7400
  • Fax: 630-897-7539
Mailing address:
  • Phone: 630-966-7400
  • Fax: 630-897-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: