| Rajiv Kandala M D S C | |
|
7531 S Stony Island #152 Chicago IL 60649 | |
| (773) 947-2831 | |
| Not Available |
| Full Name | Rajiv Kandala M D S C |
|---|---|
| Speciality | Family Medicine |
| Location | 7531 S Stony Island, Chicago, Illinois |
| Authorized Official Name and Position | Rajiv Kandala (SECRETARY) |
| Authorized Official Contact | 7737934527 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rajiv Kandala M D S C 1720 S Michigan Ave Apt 2909 Chicago IL 60616-4861 Ph: (630) 405-5500 | Rajiv Kandala M D S C 7531 S Stony Island #152 Chicago IL 60649 Ph: (773) 947-2831 |
| NPI Number | 1114094281 |
|---|---|
| Provider Enumeration Date | 11/30/2006 |
| Last Update Date | 03/07/2023 |
| Certification Date | 08/02/2022 |
| Medicare PECOS PAC ID | 0345130977 |
|---|---|
| Medicare Enrollment ID | O20040317001451 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114094281 | NPI | - | NPPES |
| 036109208 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Rajiv Kandala |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376608059 PECOS PAC ID: 2062302094 Enrollment ID: I20040316000195 |
| Provider Name | Shakib Sakla Namas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093780926 PECOS PAC ID: 4082689658 Enrollment ID: I20040827000275 |
| Provider Name | Syed Najeeb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134275928 PECOS PAC ID: 6305884339 Enrollment ID: I20050420001036 |
| Provider Name | Syed F Ali |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225123615 PECOS PAC ID: 6507054954 Enrollment ID: I20121201000012 |
| Provider Name | Felix Ngeh Fonge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386994812 PECOS PAC ID: 1153574462 Enrollment ID: I20130118000145 |
| Provider Name | Natasha B Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649620865 PECOS PAC ID: 9335433226 Enrollment ID: I20160816001841 |
| Provider Name | Anthony Oyetola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922472968 PECOS PAC ID: 3678861481 Enrollment ID: I20161011002234 |
| Provider Name | Waseema Tajammul |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790128502 PECOS PAC ID: 1355624149 Enrollment ID: I20170201000544 |
| Provider Name | Shashanna Heard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669967543 PECOS PAC ID: 5698013084 Enrollment ID: I20190211000296 |
| Provider Name | Biaisha Y Washington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437687464 PECOS PAC ID: 3476986985 Enrollment ID: I20191213000505 |
| Provider Name | Kemberly Briggs |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235659335 PECOS PAC ID: 8729403191 Enrollment ID: I20200731001812 |
| Provider Name | Sherwonna Barron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477229334 PECOS PAC ID: 1557768173 Enrollment ID: I20210924001389 |
| Provider Name | Stephanie C Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942990015 PECOS PAC ID: 4789043514 Enrollment ID: I20230711002404 |
| Provider Name | Marquita Denise Porche |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326723578 PECOS PAC ID: 3274994215 Enrollment ID: I20230807002514 |
| Provider Name | Cynthia Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467230904 PECOS PAC ID: 7618328071 Enrollment ID: I20240110001349 |
| Provider Name | Dhara S Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104647478 PECOS PAC ID: 1759817893 Enrollment ID: I20241212000444 |
| Provider Name | Michelle Harrington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346050317 PECOS PAC ID: 6901336791 Enrollment ID: I20250210000152 |
| Provider Name | Olalekan Olumuyiwa Fasogbon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487442158 PECOS PAC ID: 8527579390 Enrollment ID: I20250618001227 |
| Provider Name | Mubbashira Aziz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477932812 PECOS PAC ID: 0648768267 Enrollment ID: I20251024000352 |
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