MEDICARE: MOVING UP FOUNDATION, INC.

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255476206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOVING UP FOUNDATION, INC.

Provider Business Mailing Address
First Line	:	10825 SCARLET DR
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-4402
Country	:	US
Telephone Number	:	773-793-4527
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 W ARMORY DR
Second Line	:
City	:	SOUTH HOLLAND
State	:	IL
Zip	:	60473-2824
Country	:	US
Telephone Number	:	708-596-0410
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAJIV KANDALA
Credential	:	M.D.
Telephone Number	:	773-793-4527

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	03/03/2008

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Directions to “MOVING UP FOUNDATION, INC. ” Practice Location

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