DR. BANU PRASAD MYNENI (NPI# 1780082693) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780082693 |
| Entity Type | Individual |
| Full Name | DR. BANU PRASAD MYNENI |
| Credential | D.O. |
| Practice Address |
7734 W North Ave Elmwood Park IL 60707-4124 |
| Mailing Address |
3235 Academy Ave Portsmouth VA 23703-3200 |
| Practice Telephone | 7086603900 |
| Mailing Telephone | 7574847386 |
| Mailing Fax Number | 7574841913 |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2020-06-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 0102206019 | VA | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 036-144866 | IL | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3235 Academy Ave Ste 101, Portsmouth, VA 237033200 | 7574847386 | |
| 425 W. Fifth Street, East Liverpool City Hospital, East Liverpool, OH 43920 | 3303857200 |
| Street Address |
7734 W NORTH AVE |
| City | ELMWOOD PARK |
| State | IL |
| Zip Code | 60707-4124 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821314105 | Kimberly Harden | Family Medicine | 7734 W North Ave, Elmwood Park, IL 60707-4124 | 2010-04-12 |
| 1891314613 | Jaymee Sygaco | Registered Nurse | 7734 W North Ave, Elmwood Park, IL 60707-4124 | 2020-04-12 |
| 1326318627 | Rush Oak Park Physicians Group Elmwood Park | Family Medicine | 7734 W North Ave, Elmwood Park, IL 60707-4124 | 2012-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679077408 | Karen Ennis, Slp, Inc. | Speech-Language Pathologist | 1709 73rd Ct, Elmood Park, IL 60707 | 2018-03-19 |
| 1518324995 | Dosha Grant | Registered Nurse | 2317 N Rutherford, Elmwood Park, IL 60707 | 2016-01-15 |
| 1962774794 | Oak Park Dental Group | Dentist | 7034 W. North Ave., Chicago, IL 60707 | 2012-02-09 |
| 1326277005 | Resurrection Services | Internal Medicine | 2433 North Harlem Ave, Ste 100, Chicago, IL 60707 | 2009-07-02 |
| 1134370059 | Mefagui Dental Office P.C. | Dentist | 6913 W. Grand Ave, Chicago, IL 60707 | 2008-10-09 |
| 1821265760 | Carly M. Smith | Chiropractor | 7716 W. North, Elmwood Pk, IL 60707 | 2008-05-09 |
| 1063695096 | Henry J. Hagopian D.d.s. P.C. | Dentist | 7518 W. North Avenue, Elmwood Park, IL 60707 | 2007-12-13 |
| 1386864411 | Brian M Caraba Dds PC | Dentist | 7124 W Diversey Ave, Chicago, IL 60707 | 2007-04-30 |
| 1104041243 | Clinics for Wellness and Neuropathy, LLC | Internal Medicine | 2333 N. Harlem, Chicago, IL 60707 | 2007-04-16 |
| 1972621050 | Sid Anderson | Psychologist | 2408 Westbrook Drive, Elmwood Park, IL 60707 | 2007-03-27 |
| Find all providers in zip 60707 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649694340 | Mount Sinai Hospital | Family Medicine | 1930 N Harlem Ave Apt 405, Elmwood Park, IL 60707-3758 | 2014-02-16 |
| 1821314105 | Kimberly Harden | Family Medicine | 7734 W North Ave, Elmwood Park, IL 60707-4124 | 2010-04-12 |
| 1740384338 | John J Walsh | Family Medicine | 7632 W North Ave, Elmwood Park, IL 60707 | 2006-09-12 |
| 1225068240 | Richard A Kasufkin | Family Medicine | 7230 W North Ave Ste 106b, Resurrection Immediate Care Center, Elmwood Park, IL 60707-4262 | 2006-07-04 |
| 1922037308 | Florence A Roche | Family Medicine | Resurrection Immediate Care Center, 7230 W. North Ave, Ste 106 B, Elmwood Park, IL 60707-4262 | 2006-06-30 |
| 1780642736 | Joseph D Gigante | Family Medicine | 7912 W Country Club Ln, Elmwood Park, IL 60707-3532 | 2006-05-01 |
| 1326318627 | Rush Oak Park Physicians Group Elmwood Park | Family Medicine | 7734 W North Ave, Elmwood Park, IL 60707-4124 | 2012-01-04 |
| 1487895801 | Demorest Consutants LLC | Family Medicine | 7255 W Grand Ave, Elmwood Park, IL 60707-2028 | 2009-03-14 |
| 1649459116 | Katarzyna Mencel M.d.s.c. | Family Medicine | 7740 W North Ave, Elmwood Park, IL 60707-4124 | 2007-10-31 |
| 1073792545 | Alicja Barbara Poleszak S.c. | Family Medicine | 7740 W North Ave, Elmwood Park, IL 60707-4124 | 2007-10-31 |
| Find all providers in ELMWOOD PARK | ||||
| City | ELMWOOD PARK |
| Zip Code | 60707 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.