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General NPI Number Information
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NPI Number | 1427218452
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Entity Type | Organization
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Legal Business Name | VASANTHA KUMARAIAH,MD,SC
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 17732 OAK PARK AVE SUITE E
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City | TINLEY PARK
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State | IL
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Zip | 60477-3934
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Country | US
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Telephone | 708-532-5500
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Fax | 708-532-5525
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Provider Business Mailing Address
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Address Line | 17732 OAK PARK AVE SUITE E
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City | TINLEY PARK
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State | IL
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Zip | 60477-3934
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Country | US
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Telephone | 708-532-5500
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Fax | 708-532-5525
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Authorized Official
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Title or Position | OFFICER
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Name | DR. VASANTHA KUMARAIAH
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Credential | MD
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Telephone | 708-532-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 036048395
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License Number State | IL
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