| Dr Premesh Malapati | |
|
5600 W Addison St Lowr 1ll Chicago IL 60634-4444 | |
| (630) 748-9373 | |
| Not Available |
| Full Name | Dr Premesh Malapati |
|---|---|
| Speciality | Internal Medicine |
| Location | 5600 W Addison St Lowr 1ll, Chicago, Illinois |
| Authorized Official Name and Position | Premesh Malapati (OWNER) |
| Authorized Official Contact | 6307489373 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Premesh Malapati 824 Marengo Ave Forest Park IL 60130-2033 Ph: (630) 748-9373 | Dr Premesh Malapati 5600 W Addison St Lowr 1ll Chicago IL 60634-4444 Ph: (630) 748-9373 |
| NPI Number | 1790161289 |
|---|---|
| Provider Enumeration Date | 08/06/2015 |
| Last Update Date | 09/12/2021 |
| Medicare PECOS PAC ID | 9537476031 |
|---|---|
| Medicare Enrollment ID | O20150916001020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790161289 | NPI | - | NPPES |
| 036114832 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036114832 (Illinois) | Primary |
| Provider Name | Premesh Malapati |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1730136763 PECOS PAC ID: 8921017963 Enrollment ID: I20060419000302 |
| Provider Name | Okechi U Odoka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174860498 PECOS PAC ID: 1850536301 Enrollment ID: I20130404000113 |
| Provider Name | Cynthia L Hammond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992171326 PECOS PAC ID: 9830405745 Enrollment ID: I20150908001789 |
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