Healthcare Provider Details

I. General information

NPI: 1437261963
Provider Name (Legal Business Name): PRATIP KUMAR NAG M.D. PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 WATERSIDE DR
SOUTH ELGIN IL
60177-3715
US

IV. Provider business mailing address

734 WATERSIDE DR
SOUTH ELGIN IL
60177-3715
US

V. Phone/Fax

Practice location:
  • Phone: 708-575-7255
  • Fax: 708-668-7826
Mailing address:
  • Phone: 708-575-7255
  • Fax: 708-668-7826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-133213
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM4388
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number036133213
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number036133213
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number96532
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: