Healthcare Provider Details

I. General information

NPI: 1972200228
Provider Name (Legal Business Name): ANNA V PRAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2248 S MICHIGAN AVE
CHICAGO IL
60616-5258
US

IV. Provider business mailing address

6332 W FITCH AVE
CHICAGO IL
60646-1016
US

V. Phone/Fax

Practice location:
  • Phone: 312-842-5083
  • Fax:
Mailing address:
  • Phone: 773-544-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: