Individual
CHANDUPATLA PRABHAKAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
559 N WESTGATE, JACKSONVILLE, IL 62650
(217) 243-5474
(217) 245-2322
Mailing address
559 N WESTGATE, JACKSONVILLE, IL 62650
(217) 243-5474
(217) 245-2322
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036056832
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036056832
—
IL
Enumeration date
08/29/2006
Last updated
05/03/2012
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