Healthcare Provider Details

I. General information

NPI: 1871029280
Provider Name (Legal Business Name): PRATIVA PANDEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 S HOSPITAL DR
MURPHYSBORO IL
62966-3333
US

IV. Provider business mailing address

PO BOX 3988
CARBONDALE IL
62902-3988
US

V. Phone/Fax

Practice location:
  • Phone: 618-684-3156
  • Fax: 618-684-1040
Mailing address:
  • Phone: 618-684-3156
  • Fax: 618-684-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036.151303
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: