MEDICARE: VETERANS ADMINISTRATION

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	207R00000X	Internal Medicine Physician	036097423	IL

General Provider Information

NPI Number	:	1518071877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VETERANS ADMINISTRATION

Provider Business Mailing Address
First Line	:	7810 CIRCLE DR
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-8011
Country	:	US
Telephone Number	:	630-662-0393
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 E 15TH ST
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3459
Country	:	US
Telephone Number	:	708-756-5454
Fax Number	:

Authorized Official
Title or Position	:	ATTENDING PHYSICIAN
Name	:	DR. SANJAY PENMETCHA
Credential	:	MD
Telephone Number	:	708-756-5454

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	06/18/2008

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Directions to “VETERANS ADMINISTRATION ” Practice Location

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