Provider Demographics
NPI:1619295953
Name:VENKATARAJAN, SANGEETHA (MD)
Entity Type:Individual
Prefix:
First Name:SANGEETHA
Middle Name:
Last Name:VENKATARAJAN
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 1:5201 WILLOW SPRINGS RD STE 320
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6539
Mailing Address - Country:US
Mailing Address - Phone:708-482-3213
Mailing Address - Fax:
Practice Address - Street 1:500 E 22ND ST STE D
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6102
Practice Address - Country:US
Practice Address - Phone:630-426-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7046207N00000X, 207R00000X
IL036.150394207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine