MEDICARE: MELISSA K PRADHAN MD

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
1	207R00000X	Internal Medicine Physician	044275	CT

General Provider Information

NPI Number	:	1588681431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA K PRADHAN MD

Provider Business Mailing Address
First Line	:	18210 LA GRANGE RD
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60487-7722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18210 LA GRANGE RD
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60487-7722
Country	:	US
Telephone Number	:	708-684-1562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	12/21/2021

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