=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225712953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NISHAAN NAGARAKANTI DO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2023
-----------------------------------------------------
Last Update Date | 06/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9715 WOODS DR UNIT 506
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-4440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-697-3594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9715 WOODS DR UNIT 506
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-4440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-697-3594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCOUNT MANAGER
-----------------------------------------------------
Name | ROMAN HNATIW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-241-1495
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------