1154529618 NPI number — DR. KESAVA KRISHNA BHOGARAJU M.D.

Table of content: DR. KESAVA KRISHNA BHOGARAJU M.D. (NPI 1154529618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154529618 NPI number — DR. KESAVA KRISHNA BHOGARAJU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHOGARAJU
Provider First Name:
KESAVA
Provider Middle Name:
KRISHNA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BHOGARAJU
Provider Other First Name:
KESAVA
Provider Other Middle Name:
KRISHNA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1154529618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 MIDDLETON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INVERNESS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60010-6136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-946-6169
Provider Business Mailing Address Fax Number:
847-428-5231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 MIDDLETON LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INVERNESS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60010-6136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-946-6169
Provider Business Practice Location Address Fax Number:
847-428-5231
Provider Enumeration Date:
07/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com