Provider Demographics
NPI:1194722108
Name:KALAWADIA, SEJAL (MD)
Entity type:Individual
Prefix:DR
First Name:SEJAL
Middle Name:
Last Name:KALAWADIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:13755 CICERO AVE
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60418-1824
Practice Address - Country:US
Practice Address - Phone:708-388-0499
Practice Address - Fax:708-388-0283
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096965207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096965Medicaid
ILL79307Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
IL036096965Medicaid
IL922820Medicare ID - Type UnspecifiedGROUP NUMBER
ILC30486Medicare PIN