Organization Name: | BALA KANAGARAJU, M.D.S.C |
NPI Number: | 1295050821 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BALA R KANAGARAJU (OWNER) |
Mailing Address: | 7914 S Ashland Ave Chicago |
State: | IL US |
Postal Code: | 606204335 |
Phone Number: | 7736516800 |
Fax Number: | |
NPI Enumeration Date: | 04/07/2010 |
NPI Last Update Date: | 04/07/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |