Healthcare Provider Details

I. General information

NPI: 1578117024
Provider Name (Legal Business Name): PRAGNA MUKESH DHOLAKIA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21481 N RAND RD
KILDEER IL
60047-3061
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-2500
  • Fax: 847-618-2809
Mailing address:
  • Phone: 847-618-2500
  • Fax: 847-618-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000838
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209030804
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: