Provider Demographics
NPI:1609029511
Name:BOMMARAJU, KALKI (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KALKI
Middle Name:
Last Name:BOMMARAJU
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2154 W DIVISION ST APT 402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8152
Mailing Address - Country:US
Mailing Address - Phone:224-703-3244
Mailing Address - Fax:
Practice Address - Street 1:2154 W DIVISION ST APT 402
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-8152
Practice Address - Country:US
Practice Address - Phone:224-703-3244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.096303207R00000X
IL036127317208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036127317Medicaid
IL036127317Medicaid