Provider Demographics
NPI:1699883595
Name:BAJAJ, MADHURI (MD)
Entity type:Individual
Prefix:DR
First Name:MADHURI
Middle Name:
Last Name:BAJAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADHURI
Other - Middle Name:
Other - Last Name:IDUPULAPATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8940 N. WOOD SAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615
Mailing Address - Country:US
Mailing Address - Phone:309-243-3000
Mailing Address - Fax:309-243-3215
Practice Address - Street 1:8940 N. WOOD SAGE ROAD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615
Practice Address - Country:US
Practice Address - Phone:309-243-3000
Practice Address - Fax:309-243-3215
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130745207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL616880015Medicare PIN