Healthcare Provider Details

I. General information

NPI: 1891889812
Provider Name (Legal Business Name): PRADEEP THAPAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10745 165TH ST
ORLAND PARK IL
60467-8713
US

IV. Provider business mailing address

10745 165TH ST
ORLAND PARK IL
60467-8713
US

V. Phone/Fax

Practice location:
  • Phone: 708-799-8384
  • Fax: 708-799-1305
Mailing address:
  • Phone: 708-799-8384
  • Fax: 708-799-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.084950
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036.084950
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: