Healthcare Provider Details

I. General information

NPI: 1346455185
Provider Name (Legal Business Name): RAJANI KOSURI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SUPERIOR ST STE 204
MELROSE PARK IL
60160-4156
US

IV. Provider business mailing address

PO BOX 5391
WOODRIDGE IL
60517-0391
US

V. Phone/Fax

Practice location:
  • Phone: 219-299-3388
  • Fax: 708-338-1780
Mailing address:
  • Phone: 219-299-3388
  • Fax: 708-338-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301086504
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036123880
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: