Provider Demographics
NPI:1194927285
Name:KATHIRESAN, ANUPAMA SQ (MD)
Entity type:Individual
Prefix:MS
First Name:ANUPAMA
Middle Name:SQ
Last Name:KATHIRESAN
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 1:333 S DESPLAINES ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5514
Mailing Address - Country:US
Mailing Address - Phone:786-537-7327
Mailing Address - Fax:
Practice Address - Street 1:500 BROADWAY STE 7
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2988
Practice Address - Country:US
Practice Address - Phone:347-343-4475
Practice Address - Fax:646-741-8785
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5451207VE0102X
CAA120939207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology