Healthcare Provider Details

I. General information

NPI: 1134600323
Provider Name (Legal Business Name): GEETANJALEE HARIDAS KADAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

901 S ASHLAND AVE APT NO1005
CHICAGO IL
60607-4001
US

V. Phone/Fax

Practice location:
  • Phone: 312-420-6328
  • Fax:
Mailing address:
  • Phone: 312-420-6328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number036154944
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036154944
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: