Organization
PRASAD GOURINENI M.D.S.C.
Active
Other names
Pediatric & Young Adult Orthopaedics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRASAD GOURINENI M.D. (PRESIDENT)
(630) 789-9223
Entity
Organization
Contact information
Practice address
4440 W.95TH STREET, PEDIATRIC AMBULATORY CLINIC, OAK LAWN, IL 60453
(708) 684-4563
(707) 684-4763
Mailing address
3420 ADAMS ROAD, OAK BROOK, IL 60523
(630) 789-9223
(630) 242-8307
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036-092558
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-092558
—
IL
Enumeration date
12/11/2006
Last updated
07/02/2014
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