# PRASAD GOURINENI M.D.S.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pediatric & Young Adult Orthopaedics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689734881
- **Authorized official:** DR. PRASAD GOURINENI M.D. (PRESIDENT)
- **Authorized official phone:** (630) 789-9223

## Contact information

- **Practice address:** 4440 W.95TH STREET, PEDIATRIC AMBULATORY CLINIC, OAK LAWN, IL 60453
- **Practice address phone:** (708) 684-4563
- **Practice address fax:** (707) 684-4763
- **Mailing address:** 3420 ADAMS ROAD, OAK BROOK, IL 60523
- **Mailing address phone:** (630) 789-9223
- **Mailing address fax:** (630) 242-8307

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 036-092558 | IL | Yes |

## Other

- **Enumeration date:** 12/11/2006
- **Last updated:** 07/02/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036-092558 | — | IL |