Organization
INDEPENDENT MEDICAL GROUP SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAJASEKHAR KOLLA MD (OWNER)
(773) 386-4797
Entity
Organization
Contact information
Practice address
100 BATSON CT STE 204, NEW LENOX, IL 60451-1571
(815) 462-1200
Mailing address
11039 VENEZIA DR, FRANKFORT, IL 60423-9044
(773) 386-4797
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/27/2019
Last updated
09/03/2019
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