Individual
PRAKASH VAISHNAV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10604 SOUTHWEST HIGHWAY, SUITE 107, CHICAGO RIDGE, IL 60415-2717
(708) 371-8006
(708) 389-6630
Mailing address
10604 SOUTHWEST HIGHWAY, SUITE 107, CHICAGO RIDGE, IL 60415-2717
(708) 371-8006
(708) 389-6630
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036058269
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632457
BLUE CROSS BLUE SHIELD
IL
05
—
036058269
—
IL
01
—
P00134276
RAILROAD MEDICARE
IL
Enumeration date
04/12/2006
Last updated
06/07/2018
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