Healthcare Provider Details

I. General information

NPI: 1982697785
Provider Name (Legal Business Name): PRASAD GOURINENI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 S ROBERTS RD
PALOS HILLS IL
60465-1971
US

IV. Provider business mailing address

10330 S ROBERTS RD
PALOS HILLS IL
60465-1971
US

V. Phone/Fax

Practice location:
  • Phone: 708-237-7200
  • Fax: 708-237-7201
Mailing address:
  • Phone: 708-237-7200
  • Fax: 708-237-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number036-092558
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036-092558
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: