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General NPI Number Information
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NPI Number | 1326330028
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Entity Type | Organization
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Legal Business Name | KIRAN POLAVARAPU MD SC
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 2348 N LISTER AVE 305
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City | CHICAGO
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State | IL
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Zip | 60614-2994
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Country | US
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Telephone | 773-710-6128
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Fax |
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Provider Business Mailing Address
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Address Line | 2348 N LISTER AVE 305
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City | CHICAGO
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State | IL
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Zip | 60614-2994
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Country | US
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Telephone | 773-710-6128
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | KIRAN POLAVARAPU
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Credential | M.D.
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Telephone | 773-710-6128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 036126768
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License Number State | IL
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