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Individual

SANJEEV KUMAR PRADHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
20060 GOVERNORS DR STE 100, OLYMPIA FIELDS, IL 60461-1029
(708) 821-7794
Mailing address
15538 ROYAL GLEN CT, ORLAND PARK, IL 60467-4577
(708) 821-7794

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036-120607
IL
2086S0129X
Vascular Surgery Physician
Primary
036-120607
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01618941
BCBS
IL
05
036120607
IL
05
200913040B
IN
Enumeration date
05/01/2008
Last updated
09/04/2024
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