MEDICARE: DR. KIRUTHIKA NAGENDRAN OD

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	152W00000X	Optometrist	046011265	IL

General Provider Information

NPI Number	:	1760952899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRUTHIKA NAGENDRAN OD

Provider Business Mailing Address
First Line	:	1013 S LAFLIN ST APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4619
Country	:	US
Telephone Number	:	312-282-1413
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1308
Country	:	US
Telephone Number	:	773-862-5000
Fax Number	:

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

Provider Enumeration Date	:	12/02/2018
Last Update Date	:	11/11/2021

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