Healthcare Provider Details

I. General information

NPI: 1639822737
Provider Name (Legal Business Name): PRI CHICAGO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 10/27/2023
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 W INDUSTRIAL DR STE 112
ELMHURST IL
60126-1608
US

IV. Provider business mailing address

188 W INDUSTRIAL DR STE 110
ELMHURST IL
60126-1608
US

V. Phone/Fax

Practice location:
  • Phone: 847-730-3276
  • Fax: 847-201-2543
Mailing address:
  • Phone: 630-941-8190
  • Fax: 847-510-0545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: NEELESH PATEL
Title or Position: ACCOUNT OFFICER
Credential:
Phone: 847-730-3276