MEDICARE: MOUNTSINAI HOSPITAL

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	208000000X	Pediatrics Physician		IL

General Provider Information

NPI Number	:	1083861926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTSINAI HOSPITAL

Provider Business Mailing Address
First Line	:	1500 S CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1729
Country	:	US
Telephone Number	:	773-257-6183
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 S CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1729
Country	:	US
Telephone Number	:	773-257-6183
Fax Number	:

Authorized Official
Title or Position	:	PGY-2
Name	:	MRS. RADHIKA DASARAJU
Credential	:	M.D
Telephone Number	:	309-660-1837

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	08/22/2008

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Directions to “MOUNTSINAI HOSPITAL ” Practice Location

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