MEDICARE: DR. BANGARUSWAMY CHANDRAMOULI M.D.

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	207UN0902X	Nuclear Imaging & Therapy Physician	18999	NE

General Provider Information

NPI Number	:	1962501544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BANGARUSWAMY CHANDRAMOULI M.D.

Provider Business Mailing Address
First Line	:	1521 FORDHAM CT
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-2914
Country	:	US
Telephone Number	:	630-778-1749
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 S DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3730
Country	:	US
Telephone Number	:	312-569-6435
Fax Number	:

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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