Healthcare Provider Details

I. General information

NPI: 1255325668
Provider Name (Legal Business Name): FRANCIS M. PRENDERGAST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 9
CHICAGO IL
60611
US

IV. Provider business mailing address

225 E CHICAGO AVE # 9
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4500
  • Fax:
Mailing address:
  • Phone: 312-227-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.102600
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036102600
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number036.102600
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: