Healthcare Provider Details

I. General information

NPI: 1952361909
Provider Name (Legal Business Name): RAJESH KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 N CLARK ST CHILDRENS MEMORIAL HOSPITAL OUTPATIENT CENTER
CHICAGO IL
60614
US

IV. Provider business mailing address

2300 CHILDRENS PLAZA #60 CHILDRENS MEMORIAL HOSPITAL
CHICAGO IL
60614
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6010
  • Fax: 312-227-9401
Mailing address:
  • Phone: 312-227-6010
  • Fax: 312-227-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number036103568
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: