MEDICARE: SONA KALOUSDIAN MD, MPH

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	036.064224	IL
2	2083P0901X	Public Health & General Preventive Medicine Physician	036.064224	IL

General Provider Information

NPI Number	:	1790025880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONA KALOUSDIAN MD, MPH

Provider Business Mailing Address
First Line	:	1845 N HOYNE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 N HOYNE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5543
Country	:	US
Telephone Number	:	773-384-4915
Fax Number	:

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

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	02/26/2013

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