MEDICARE: BALA KANAGARAJU, M.D.S.C

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1295050821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALA KANAGARAJU, M.D.S.C

Provider Business Mailing Address
First Line	:	1807 VOLLMER RD
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-1960
Country	:	US
Telephone Number	:	708-799-0234
Fax Number	:

Provider Business Practice Location Address
First Line	:	7914 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-4335
Country	:	US
Telephone Number	:	773-651-6800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BALA R KANAGARAJU
Credential	:	M.D
Telephone Number	:	708-799-0234

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	04/07/2010

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