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Individual
PINNAMANENI PRASAD
Active
Individual
PINNAMANENI PRASAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036049086
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020057300
BLACK LUNG
IL
01
—
036049086
IL STATE LICENSE
IL
05
—
036049086
—
IL
01
—
053701
HEALTH ALLIANCE
IL
01
—
08421024
BC/BS
IL
01
—
102120
HEALTHLINK
IL
01
—
110140986
RR MEDICARE PIN
IL
01
—
133586700
ACS-OWCP
IL
01
—
14D0949277
CLIA
IL
01
—
170775
PERSONAL CARE
IL
01
—
6394P
CATERPILLAR
IL
01
—
CD7143
RR MEDICARE GROUP#
IL
Enumeration date
08/09/2006
Last updated
01/03/2022
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