Provider Demographics
NPI:1518943513
Name:BAJAJ, AJAY (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:BAJAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 W 79TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1554
Mailing Address - Country:US
Mailing Address - Phone:708-636-0006
Mailing Address - Fax:708-636-0007
Practice Address - Street 1:4901 W 79TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1554
Practice Address - Country:US
Practice Address - Phone:708-636-0006
Practice Address - Fax:708-636-0007
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078076207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL995271OtherMEDICARE GROUP
IL01621679OtherBCBS OF IL
IL995270OtherMEDICARE GROUP
IL036078076Medicaid
21608842OtherBCBS IL
IL995270OtherMEDICARE GROUP
ILD 16786Medicare UPIN
ILK14825Medicare ID - Type Unspecified
21608842OtherBCBS IL