Healthcare Provider Details

I. General information

NPI: 1205716636
Provider Name (Legal Business Name): AJANTA KUMARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

3174 N HUDSON AVE APT 11
CHICAGO IL
60657-8572
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-6730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.085343
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: