Healthcare Provider Details

I. General information

NPI: 1508110990
Provider Name (Legal Business Name): BINAL KIRAN MAHARAJA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E SUPERIOR SUITE 306
CHICAGO IL
60611-8856
US

IV. Provider business mailing address

1 W SUPERIOR ST APT 4216
CHICAGO IL
60654-8803
US

V. Phone/Fax

Practice location:
  • Phone: 312-754-9404
  • Fax: 312-754-9402
Mailing address:
  • Phone: 347-882-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036140846
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: