MEDICARE: DR. ANJU MOHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0363147982	IL
2	207R00000X	Internal Medicine Physician	DR.0058000	CO
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207RN0300X	Nephrology Physician	0363147982	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	028508	OTHER	CO	KIASER COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1053739896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANJU MOHAN MD

Provider Business Mailing Address
First Line	:	PO BOX 713260
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-1260
Country	:	US
Telephone Number	:	630-469-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 SILVER CROSS BLVD STE 240
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-8646
Country	:	US
Telephone Number	:	630-873-8889
Fax Number	:	630-456-7138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2014
Last Update Date	:	09/05/2023

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Directions to “ DR. ANJU MOHAN MD” Practice Location

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