Provider Demographics
NPI:1386131720
Name:TATHINENI, PRAVEENA (DO)
Entity type:Individual
Prefix:
First Name:PRAVEENA
Middle Name:
Last Name:TATHINENI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E 13TH ST APT 2103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3260
Mailing Address - Country:US
Mailing Address - Phone:718-213-8917
Mailing Address - Fax:
Practice Address - Street 1:120 SPALDING DR STE 308
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6521
Practice Address - Country:US
Practice Address - Phone:630-646-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1386131720207R00000X
IL036.156225207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine