Healthcare Provider Details

I. General information

NPI: 1447282678
Provider Name (Legal Business Name): PRANAV P. VYAS D.C., FIAMA.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 ELA RD STE B
LAKE ZURICH IL
60047-2412
US

IV. Provider business mailing address

755 ELA RD STE B
LAKE ZURICH IL
60047-2412
US

V. Phone/Fax

Practice location:
  • Phone: 847-550-6500
  • Fax: 847-550-6595
Mailing address:
  • Phone: 847-550-6500
  • Fax: 847-550-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038-009916
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: