Healthcare Provider Details

I. General information

NPI: 1437113461
Provider Name (Legal Business Name): PRAVEEN VOHRA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24039 W LOCKPORT ST
PLAINFIELD IL
60544-1652
US

IV. Provider business mailing address

PO BOX 678
PLAINFIELD IL
60544-0678
US

V. Phone/Fax

Practice location:
  • Phone: 815-254-3338
  • Fax: 815-436-8367
Mailing address:
  • Phone: 815-254-3338
  • Fax: 815-436-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016-004798
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier09908116
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: