Provider Demographics
NPI:1427038413
Name:MAJUMDAR, MANJUSRI (MD)
Entity Type:Individual
Prefix:
First Name:MANJUSRI
Middle Name:
Last Name:MAJUMDAR
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:WIRTZ DR
Mailing Address - Street 2:HEALTH SERVICES NIU
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115
Mailing Address - Country:US
Mailing Address - Phone:815-753-1311
Mailing Address - Fax:815-753-9599
Practice Address - Street 1:WIRTZ DR
Practice Address - Street 2:HEALTH SERVICES NIU
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115
Practice Address - Country:US
Practice Address - Phone:815-753-1311
Practice Address - Fax:815-753-9599
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine