Provider Demographics
NPI:1881628840
Name:RAJASEKHAR, KANCHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:KANCHANA
Middle Name:
Last Name:RAJASEKHAR
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 1:4700 W 95TH ST
Mailing Address - Street 2:SUITE # LL2
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2533
Mailing Address - Country:US
Mailing Address - Phone:708-423-6400
Mailing Address - Fax:708-423-6428
Practice Address - Street 1:4700 W 95TH ST
Practice Address - Street 2:SUITE # LL2
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2533
Practice Address - Country:US
Practice Address - Phone:708-423-6400
Practice Address - Fax:708-423-6428
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052145208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE30348Medicare UPIN