Individual
PRAKASH PEDAPATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3535 N BELL SCHOOL RD, ROCKFORD, IL 61114
(779) 696-9400
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
(779) 696-7342
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
036058366
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036058366
—
IL
Enumeration date
07/18/2006
Last updated
02/22/2021
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