Basic Information
| Provider Information | |||||||||
| NPI: | 1316118110 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEJVIR NANDA MD SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 903 COMMERCE DR | ||||||||
| Address2: | SUITE 333 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305716770 | ||||||||
| FaxNumber: | 6305718810 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 S MICHIGAN AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606033211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122630099 | ||||||||
| FaxNumber: | 3129771188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2008 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | NANDA | ||||||||
| AuthorizedOfficialFirstName: | TEJVIR | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3122630099 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.