Provider Demographics
NPI:1578117024
Name:DHOLAKIA, PRAGNA MUKESH (APRN)
Entity type:Individual
Prefix:
First Name:PRAGNA
Middle Name:MUKESH
Last Name:DHOLAKIA
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-618-2500
Mailing Address - Fax:847-618-2809
Practice Address - Street 1:21481 N RAND RD
Practice Address - Street 2:
Practice Address - City:KILDEER
Practice Address - State:IL
Practice Address - Zip Code:60047-3061
Practice Address - Country:US
Practice Address - Phone:847-618-2500
Practice Address - Fax:847-618-2809
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000838363LF0000X
IL209030804363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271929223OtherTIN