Provider Demographics
NPI:1477684769
Name:VIJAY BAJAJ M.D.,S.C.
Entity Type:Organization
Organization Name:VIJAY BAJAJ M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-598-4430
Mailing Address - Street 1:10401 S ROBERTS RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1991
Mailing Address - Country:US
Mailing Address - Phone:708-598-4430
Mailing Address - Fax:708-598-4478
Practice Address - Street 1:10401 S ROBERTS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1991
Practice Address - Country:US
Practice Address - Phone:708-598-4430
Practice Address - Fax:708-598-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45730Medicare UPIN
IL695040Medicare ID - Type Unspecified