Healthcare Provider Details

I. General information

NPI: 1063955987
Provider Name (Legal Business Name): PUNYA NARAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2016
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 W WINDSOR AVE
BERWYN IL
60402-3441
US

IV. Provider business mailing address

632 W WELLINGTON AVE APT 1W
CHICAGO IL
60657-5356
US

V. Phone/Fax

Practice location:
  • Phone: 352-217-3231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036172754
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: