MEDICARE: DR. KIRAN NIMMAGADDA MD

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	207RG0100X	Gastroenterology Physician	036104779	IL

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	:	1720071293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRAN NIMMAGADDA MD

Provider Business Mailing Address
First Line	:	259 E ERIE ST
Second Line	:	SUITE 2250
City	:	CHICAGO
State	:	IL
Zip	:	60611-2987
Country	:	US
Telephone Number	:	312-926-6000
Fax Number	:	312-926-6165

Provider Business Practice Location Address
First Line	:	259 E ERIE ST
Second Line	:	SUITE 2250
City	:	CHICAGO
State	:	IL
Zip	:	60611-2987
Country	:	US
Telephone Number	:	312-926-6000
Fax Number	:	312-926-6165

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	05/16/2016

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