Provider Demographics
NPI:1164603007
Name:KAMALESH BABU,MD
Entity Type:Organization
Organization Name:KAMALESH BABU,MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMALESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BABU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-273-6546
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46546-0308
Mailing Address - Country:US
Mailing Address - Phone:574-273-6546
Mailing Address - Fax:574-273-5295
Practice Address - Street 1:1423 CHICAGO RD
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3400
Practice Address - Country:US
Practice Address - Phone:708-799-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF01986Medicare UPIN
IL598940Medicare PIN