Individual
LAWRENCE P PRABHAKAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5668 E STATE ST, ROCKFORD, IL 61108-2464
(815) 229-7580
(815) 229-7585
Mailing address
5668 E STATE ST, ROCKFORD, IL 61108-2464
(815) 229-7580
(815) 229-7585
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
036098121
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036098121
—
IL
01
—
280000796
RAILROAD MEDICARE
—
05
—
32473900
—
WI
Enumeration date
07/03/2006
Last updated
10/06/2015
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