Provider Demographics
NPI:1346455185
Name:KOSURI, RAJANI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJANI
Middle Name:
Last Name:KOSURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5391
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-0391
Mailing Address - Country:US
Mailing Address - Phone:312-473-0083
Mailing Address - Fax:708-338-1780
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:708-689-8539
Practice Address - Fax:708-338-1780
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086504207R00000X
IL036123880207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400127133Medicare PIN
ILF400127131Medicare PIN