Individual
VASANTHA KUMARAIAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4400 W 95TH ST, SUITE 311, OAK LAWN, IL 60453-2654
(708) 424-9710
Mailing address
62647 COLLECTION CENTER DR, CHICAGO, IL 60693-0626
(708) 478-4302
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036048395
IL
207RH0003X
Hematology & Oncology Physician
Primary
036048395
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036048395
—
IL
Enumeration date
11/30/2006
Last updated
03/07/2016
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