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NPI Code Detail

MEDICARE: MARK PRAKASH

MEDICARE: MARK PRAKASH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist019036491IL

General Provider Information

NPI Number : 1043914898
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK PRAKASH
Provider Business Mailing Address
First Line : 3860 W OGDEN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60623-2460
Country : US
Telephone Number : 212-305-6100
Fax Number :
Provider Business Practice Location Address
First Line : 3860 W OGDEN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60623-2460
Country : US
Telephone Number : 212-305-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2023
Last Update Date : 03/12/2026

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Directions to “ MARK PRAKASH ” Practice Location

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