MEDICARE: BALA KANAGARAJU 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	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1851315469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BALA KANAGARAJU MD

Provider Business Mailing Address
First Line	:	1807 VOLLMER RD
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422
Country	:	US
Telephone Number	:	773-651-6800
Fax Number	:	773-651-1420

Provider Business Practice Location Address
First Line	:	7914 S ASHLAND
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620
Country	:	US
Telephone Number	:	773-651-6800
Fax Number	:	773-651-1420

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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