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NPI Code Detail

MEDICARE: PRANJAL M AGRAWAL M.D.

MEDICARE: PRANJAL M AGRAWAL M.D.
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
1208M00000XHospitalist Physician036-118796IL
2207R00000XInternal Medicine Physician036-118796IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
180020007OTHERILMEDICARE PTAN
5K40163OTHERILMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2036-118796OTHERILILLINOIS PHYSICIAN & SURG
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4336-080021OTHERILILLINOIS CONTROLLED SUBST

General Provider Information

NPI Number : 1174723290
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRANJAL M AGRAWAL M.D.
Provider Business Mailing Address
First Line : 102 S HENNEPIN AVE
Second Line :
City : DIXON
State : IL
Zip : 61021-3013
Country : US
Telephone Number : 815-285-8535
Fax Number : 815-285-8922
Provider Business Practice Location Address
First Line : 102 S HENNEPIN AVE
Second Line :
City : DIXON
State : IL
Zip : 61021-3013
Country : US
Telephone Number : 815-284-7733
Fax Number : 815-288-1487
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2007
Last Update Date : 11/12/2024

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Directions to “ PRANJAL M AGRAWAL M.D.” Practice Location

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