MEDICARE: DR. SUJATHA KAILAS 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	30129	WI
2	207RG0100X	Gastroenterology Physician	036.134009	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110114149	OTHER	WI	RAILROAD MEDICARE
3	F400429459	OTHER	IL	MEDICARE

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	:	1861473936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUJATHA KAILAS MD

Provider Business Mailing Address
First Line	:	5744 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-4302
Country	:	US
Telephone Number	:	312-335-0180
Fax Number	:	773-275-4679

Provider Business Practice Location Address
First Line	:	5744 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-4302
Country	:	US
Telephone Number	:	312-335-0180
Fax Number	:	773-275-4679

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	03/22/2018

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Directions to “ DR. SUJATHA KAILAS MD” Practice Location

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