Healthcare Provider Details

I. General information

NPI: 1164603007
Provider Name (Legal Business Name): KAMALESH BABU,MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 CHICAGO RD
CHICAGO HEIGHTS IL
60411-3400
US

IV. Provider business mailing address

PO BOX 308
MISHAWAKA IN
46546-0308
US

V. Phone/Fax

Practice location:
  • Phone: 708-799-1000
  • Fax:
Mailing address:
  • Phone: 574-273-6546
  • Fax: 574-273-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: KAMALESH BABU
Title or Position: OWNER
Credential: MD
Phone: 574-273-6546