Provider Demographics
NPI:1962511238
Name:KUKREJA, SUBHASH C (MD)
Entity Type:Individual
Prefix:
First Name:SUBHASH
Middle Name:C
Last Name:KUKREJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:820 S DAMEN AVE
Mailing Address - Street 2:MEDICAL SERVICE MP111 JESSE BROWN VAMC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3728
Mailing Address - Country:US
Mailing Address - Phone:312-569-6129
Mailing Address - Fax:312-569-6854
Practice Address - Street 1:820 S DAMEN AVE
Practice Address - Street 2:MEDICAL SERVICE MP111 JESSE BROWN VAMC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3728
Practice Address - Country:US
Practice Address - Phone:312-569-6129
Practice Address - Fax:312-569-6854
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILX20AMedicare UPIN