MEDICARE: DR. ANANTA RAJ PANDIT M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	036.132209	IL
2	207R00000X	Internal Medicine Physician	125058793	IL

General Provider Information

NPI Number	:	1073826327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANANTA RAJ PANDIT M.D

Provider Business Mailing Address
First Line	:	6400 SHAFER CT STE 700
Second Line	:
City	:	ROSEMONT
State	:	IL
Zip	:	60018-4989
Country	:	US
Telephone Number	:	847-692-1000
Fax Number	:	224-532-2780

Provider Business Practice Location Address
First Line	:	6224 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-2324
Country	:	US
Telephone Number	:	773-778-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2010
Last Update Date	:	02/08/2022

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