Provider Demographics
NPI:1295762417
Name:BAIS, KIRAN RAM (MD)
Entity type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:RAM
Last Name:BAIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIRAN
Other - Middle Name:RAM
Other - Last Name:BAIS GHODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:188 TIMBERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:708-344-8135
Mailing Address - Fax:708-344-8139
Practice Address - Street 1:2127 S 17TH AVE
Practice Address - Street 2:
Practice Address - City:BROADVIEW
Practice Address - State:IL
Practice Address - Zip Code:60155
Practice Address - Country:US
Practice Address - Phone:708-344-8135
Practice Address - Fax:708-344-8139
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
31602912OtherBCBS
D15003Medicare UPIN
IL693000Medicare ID - Type Unspecified
IL3160291277Medicare ID - Type Unspecified