MEDICARE: DR. KIRAN RAM BAIS 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	207Q00000X	Family Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31602912	OTHER		BCBS

General Provider Information

NPI Number	:	1295762417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRAN RAM BAIS MD

Provider Business Mailing Address
First Line	:	188 TIMBERVIEW DR
Second Line	:
City	:	OAKBROOK
State	:	IL
Zip	:	60523
Country	:	US
Telephone Number	:	708-344-8135
Fax Number	:	708-344-8139

Provider Business Practice Location Address
First Line	:	2127 S 17TH AVE
Second Line	:
City	:	BROADVIEW
State	:	IL
Zip	:	60155
Country	:	US
Telephone Number	:	708-344-8135
Fax Number	:	708-344-8139

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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