Individual
DR. PRAKASH SELVARAJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
396 REMINGTON BLVD, SUITE 340, BOLINGBROOK, IL 60440-1732
(630) 759-9800
Mailing address
3537 PAYSPHERE CIR, CHICAGO, IL 60674-0035
(708) 786-2900
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036-095872
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-095872-1
—
IL
Enumeration date
08/12/2005
Last updated
10/04/2011
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