Healthcare Provider Details

I. General information

NPI: 1306308671
Provider Name (Legal Business Name): PRATHAYINI SUBARAJAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10370 HALIGUS RD STE 117
HUNTLEY IL
60142-9582
US

IV. Provider business mailing address

10370 HALIGUS RD STE 117
HUNTLEY IL
60142-9582
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-3900
  • Fax: 847-802-7207
Mailing address:
  • Phone: 815-344-3900
  • Fax: 847-802-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036160677
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036160677
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: