Healthcare Provider Details

I. General information

NPI: 1013596584
Provider Name (Legal Business Name): KANITHRA C SEKARAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 21-100
CHICAGO IL
60611-5970
US

IV. Provider business mailing address

2500 METROHEALTH DR
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0990
  • Fax: 312-472-5270
Mailing address:
  • Phone: 216-778-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036171135
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: