Provider Demographics
NPI:1215630942
Name:BAJAJ, ANKUSH ISHWAR
Entity type:Individual
Prefix:
First Name:ANKUSH
Middle Name:ISHWAR
Last Name:BAJAJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 MIDWEST CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2526
Mailing Address - Country:US
Mailing Address - Phone:630-689-3596
Mailing Address - Fax:
Practice Address - Street 1:2011 MIDWEST CLUB PKWY
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2526
Practice Address - Country:US
Practice Address - Phone:630-689-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program