Individual
DR. PRAVEEN KUMAR SAMPATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9000
Mailing address
4101 PERCHERON BND, CEDAR PARK, TX 78613-7881
(716) 907-1096
(512) 324-4332
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036164435
IL
207RG0100X
Gastroenterology Physician
55431
AZ
207RG0100X
Gastroenterology Physician
ME117230
FL
207RG0100X
Gastroenterology Physician
Q2845
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3463192-02
—
TX
Enumeration date
01/11/2010
Last updated
05/05/2025
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