MEDICARE: AJAY BAJAJ 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	207RG0100X	Gastroenterology Physician	036078076	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	995271	OTHER	IL	MEDICARE GROUP
3	995270	OTHER	IL	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	01621679	OTHER	IL	BCBS OF IL
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	21608842	OTHER		BCBS IL

General Provider Information

NPI Number	:	1518943513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJAY BAJAJ MD

Provider Business Mailing Address
First Line	:	4901 W 79TH ST
Second Line	:	SUITE 1
City	:	BURBANK
State	:	IL
Zip	:	60459-1554
Country	:	US
Telephone Number	:	708-636-0006
Fax Number	:	708-636-0007

Provider Business Practice Location Address
First Line	:	4901 W 79TH ST
Second Line	:	SUITE 1
City	:	BURBANK
State	:	IL
Zip	:	60459-1554
Country	:	US
Telephone Number	:	708-636-0006
Fax Number	:	708-636-0007

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	06/23/2008

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Directions to “ AJAY BAJAJ MD” Practice Location

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