Healthcare Provider Details

I. General information

NPI: 1386569846
Provider Name (Legal Business Name): PRASHANT GURAGAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 EUCLID AVE STE 203
BERWYN IL
60402-6700
US

IV. Provider business mailing address

3231 EUCLID AVE STE 203
BERWYN IL
60402-6700
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-3401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125089077
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: