Provider Demographics
NPI:1962501544
Name:CHANDRAMOULI, BANGARUSWAMY (MD)
Entity Type:Individual
Prefix:DR
First Name:BANGARUSWAMY
Middle Name:
Last Name:CHANDRAMOULI
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 1:1521 FORDHAM CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2914
Mailing Address - Country:US
Mailing Address - Phone:630-778-1749
Mailing Address - Fax:
Practice Address - Street 1:920 S DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3730
Practice Address - Country:US
Practice Address - Phone:312-569-6435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18999207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy