Healthcare Provider Details

I. General information

NPI: 1194810010
Provider Name (Legal Business Name): ANANTHA KRISHNAN HARIJITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST SUITE 2E
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

840 S WOOD ST # MC856
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-4150
  • Fax: 312-996-2328
Mailing address:
  • Phone: 312-996-4185
  • Fax: 312-355-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036125470
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number247220
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: