Healthcare Provider Details

I. General information

NPI: 1437350592
Provider Name (Legal Business Name): BALU NATARAJAN MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W NORTH AVE SUITE 208
CHICAGO IL
60610-7010
US

IV. Provider business mailing address

711 W NORTH AVE SUITE 208
CHICAGO IL
60610-1174
US

V. Phone/Fax

Practice location:
  • Phone: 312-616-7778
  • Fax: 312-276-4304
Mailing address:
  • Phone: 773-616-7778
  • Fax: 312-276-4304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036101773
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number036101773
License Number StateIL

VIII. Authorized Official

Name: DR. BALAKRISHNAN NATARAJAN
Title or Position: PRESIDENT
Credential: MD
Phone: 312-616-7778