Provider Demographics
NPI:1437350592
Name:BALU NATARAJAN MD SC
Entity Type:Organization
Organization Name:BALU NATARAJAN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BALAKRISHNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NATARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-616-7778
Mailing Address - Street 1:711 W NORTH AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1174
Mailing Address - Country:US
Mailing Address - Phone:773-616-7778
Mailing Address - Fax:312-276-4304
Practice Address - Street 1:711 W NORTH AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7010
Practice Address - Country:US
Practice Address - Phone:312-616-7778
Practice Address - Fax:312-276-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101773207R00000X, 207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101773Medicaid
IL01633302OtherBLUE CROSS BLUE SHIELD
ILH29183Medicare UPIN
IL01633302OtherBLUE CROSS BLUE SHIELD