Provider Demographics
NPI:1154529618
Name:BHOGARAJU, KESAVA KRISHNA (MD)
Entity type:Individual
Prefix:DR
First Name:KESAVA
Middle Name:KRISHNA
Last Name:BHOGARAJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KESAVA
Other - Middle Name:KRISHNA
Other - Last Name:BHOGARAJU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:900 MIDDLETON LN
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6136
Mailing Address - Country:US
Mailing Address - Phone:847-946-6169
Mailing Address - Fax:847-428-5231
Practice Address - Street 1:900 MIDDLETON LN
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60010-6136
Practice Address - Country:US
Practice Address - Phone:847-946-6169
Practice Address - Fax:847-428-5231
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12570Medicare UPIN