Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036097660 | IL |
NPI | 1013032499 |
---|---|
Provider Name | Dr. Prasad Chappidi |
First Address | Glenview, IL 60025-0320 |
Second Address | Chicago, IL 60634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036097660 | (05) | IL |
G70161 | (02) |