Healthcare Provider Details

I. General information

NPI: 1831505106
Provider Name (Legal Business Name): INDUPREET NAGRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 10/20/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 ROOSEVELT RD
FOREST PARK IL
60130
US

IV. Provider business mailing address

630 N STATE ST APT 2507
CHICAGO IL
60654-5581
US

V. Phone/Fax

Practice location:
  • Phone: 708-209-4180
  • Fax: 708-209-2280
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number290528
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.146769
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: