Individual
DR. SUJATHA KAILAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5744 N BROADWAY ST, CHICAGO, IL 60660-4302
(312) 335-0180
(773) 275-4679
Mailing address
5744 N BROADWAY ST, CHICAGO, IL 60660-4302
(312) 335-0180
(773) 275-4679
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036.134009
IL
207RG0100X
Gastroenterology Physician
30129
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110114149
RAILROAD MEDICARE
WI
05
—
31576500
—
WI
01
—
F400429459
MEDICARE
IL
Enumeration date
11/07/2005
Last updated
03/22/2018
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