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NPI Code Detail

MEDICARE: DR. KOUSIKI PATRA MD

MEDICARE: DR. KOUSIKI PATRA 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
1208000000XPediatrics Physician35077993OH
22080N0001XNeonatal-Perinatal Medicine Physician35077993OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285623785
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KOUSIKI PATRA MD
Provider Business Mailing Address
First Line : 1653 W CONGRESS PKWY
Second Line : MURDOCK 622
City : CHICAGO
State : IL
Zip : 60612-3833
Country : US
Telephone Number : 312-942-6640
Fax Number : 312-942-4370
Provider Business Practice Location Address
First Line : 1653 W CONGRESS PKWY
Second Line : MURDOCK 622
City : CHICAGO
State : IL
Zip : 60612-3833
Country : US
Telephone Number : 312-942-6640
Fax Number : 312-942-4370
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 06/13/2011

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