Provider Demographics
NPI:1720058639
Name:DHANANJAYA, NEETHA (MD)
Entity Type:Individual
Prefix:
First Name:NEETHA
Middle Name:
Last Name:DHANANJAYA
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 1:210 S DESPLAINES ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5500
Mailing Address - Country:US
Mailing Address - Phone:312-654-2700
Mailing Address - Fax:312-654-9930
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:STE 203
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4159
Practice Address - Country:US
Practice Address - Phone:773-251-9786
Practice Address - Fax:866-954-5804
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108649207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108649Medicaid
IL603040/K24307Medicare ID - Type Unspecified
I48106Medicare UPIN