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General NPI Number Information
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NPI Number | 1063049807
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Entity Type | Individual
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Provider Name | BIRAAJ MANOHAR MAHAJAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 08/03/2025
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Provider Practice Location Address
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Address Line | 1775 DEMPSTER ST # 48
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City | PARK RIDGE
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State | IL
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Zip | 60068-1143
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Country | US
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Telephone | 847-723-2210
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Fax | 847-723-3394
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Provider Business Mailing Address
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Address Line | 6033 NORTH AVE APT 1E
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City | OAK PARK
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State | IL
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Zip | 60302-1284
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Country | US
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Telephone | 786-371-9391
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 036.176356
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License Number State | IL
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