Provider Demographics
NPI:1053421271
Name:PRABHU, VEENA (MD)
Entity type:Individual
Prefix:
First Name:VEENA
Middle Name:
Last Name:PRABHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:534 CHESTNUT ST
Mailing Address - Street 2:STE 210
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3167
Mailing Address - Country:US
Mailing Address - Phone:630-323-7833
Mailing Address - Fax:630-323-7410
Practice Address - Street 1:534 CHESTNUT STREET
Practice Address - Street 2:STE 210W
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3257
Practice Address - Country:US
Practice Address - Phone:630-323-7833
Practice Address - Fax:630-323-7410
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-07-13
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Provider Licenses
StateLicense IDTaxonomies
IL036091074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG53697Medicare UPIN