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General NPI Number Information
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NPI Number | 1740360106
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Entity Type | Organization
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Legal Business Name | LM PRASAD M.D S.C
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 1550 N NORTHWEST HWY 107
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City | PARK RIDGE
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State | IL
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Zip | 60068-1411
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Country | US
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Telephone | 847-759-1110
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Fax | 847-759-8273
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Provider Business Mailing Address
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Address Line | 1550 N NORTHWEST HWY 107
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City | PARK RIDGE
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State | IL
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Zip | 60068-1411
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Country | US
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Telephone | 847-759-1110
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Fax | 847-759-8273
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. LEELA M PRASAD
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Credential | M.D.
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Telephone | 847-759-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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License Number State |
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