Basic Information
| Provider Information | |||||||||
| NPI: | 1437562352 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEVARAJ | ||||||||
| FirstName: | ANJAN | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 E HURON ST STE 16-738 | ||||||||
| Address2: | NORTHWESTERN MEMORIAL HOSPITAL | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129265924 | ||||||||
| FaxNumber: | 3129266134 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 WASHINGTON ST | ||||||||
| Address2: | BIEWIND BUILDING, 3RD FLOOR, TUFTS MEDICAL CENTER | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176366366 | ||||||||
| FaxNumber: | 6176366361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2014 | ||||||||
| LastUpdateDate: | 06/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 260395 | MA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 036142260 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.