Provider Demographics
NPI:1295050821
Name:BALA KANAGARAJU, M.D.S.C
Entity type:Organization
Organization Name:BALA KANAGARAJU, M.D.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BALA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KANAGARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-799-0234
Mailing Address - Street 1:1807 VOLLMER RD
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1960
Mailing Address - Country:US
Mailing Address - Phone:708-799-0234
Mailing Address - Fax:
Practice Address - Street 1:7914 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-4335
Practice Address - Country:US
Practice Address - Phone:773-651-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty