MEDICARE: DR. JALAJAKSHI POTLURI MD, FACP

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	207RH0003X	Hematology & Oncology Physician	036-083537	IL

General Provider Information

NPI Number	:	1295760783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JALAJAKSHI POTLURI MD, FACP

Provider Business Mailing Address
First Line	:	3434 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3319
Country	:	US
Telephone Number	:	773-279-1800
Fax Number	:	773-463-3664

Provider Business Practice Location Address
First Line	:	3434 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3319
Country	:	US
Telephone Number	:	773-279-1800
Fax Number	:	773-463-3664

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/30/2011

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