Healthcare Provider Details

I. General information

NPI: 1598203390
Provider Name (Legal Business Name): HEALTH HUB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 OGDEN AVE
DOWNERS GROVE IL
60515-2602
US

IV. Provider business mailing address

1909 OGDEN AVE
DOWNERS GROVE IL
60515-2602
US

V. Phone/Fax

Practice location:
  • Phone: 630-750-7920
  • Fax:
Mailing address:
  • Phone: 630-750-7920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number036138017
License Number StateIL

VIII. Authorized Official

Name: PRASHANTH TAMRAGOURI
Title or Position: CEO
Credential: M.D.
Phone: 630-750-7920