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General NPI Number Information
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NPI Number | 1255476206
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Entity Type | Organization
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Legal Business Name | MOVING UP FOUNDATION, INC.
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 520 W ARMORY DR
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2824
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Country | US
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Telephone | 708-596-0410
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Fax |
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Provider Business Mailing Address
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Address Line | 10825 SCARLET DR
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City | ORLAND PARK
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State | IL
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Zip | 60467-4402
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Country | US
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Telephone | 773-793-4527
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAJIV KANDALA
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Credential | M.D.
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Telephone | 773-793-4527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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