Provider Demographics
NPI:1447845144
Name:IYENGAR GERIATRIC HOSPITALIST SC
Entity type:Organization
Organization Name:IYENGAR GERIATRIC HOSPITALIST SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:IYENGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-697-3729
Mailing Address - Street 1:720 S WELLS ST APT 2512
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4796
Mailing Address - Country:US
Mailing Address - Phone:773-697-3729
Mailing Address - Fax:
Practice Address - Street 1:2674 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2361
Practice Address - Country:US
Practice Address - Phone:773-697-3729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty