Active NPI
Pooja Kanthawar, MD
- Family Medicine Physician
- Chicago, IL
National Provider Identifier
1053114652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 125.085688
- Practice address
- 4600 N Ravenswood Ave
Chicago, IL 60640-4510 - Phone
- (773) 561-7500
- Fax
- (773) 561-7612
- NPI assigned
- Mar 29, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 125.085688 | IL | Primary |
Addresses
Primary practice location
4600 N Ravenswood Ave
Chicago, IL 60640-4510
Mailing address
4600 N Ravenswood Ave
Chicago, IL 60640-4510
Phone (773) 561-7500
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | securerecords.sanford.html | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.085688 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1743206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750118400000",
"number": "1053114652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4600 N RAVENSWOOD AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606404510",
"telephone_number": "773-561-7500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4600 N RAVENSWOOD AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606404510",
"telephone_number": "773-561-7500",
"fax_number": "773-561-7612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANTHAWAR",
"first_name": "POOJA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-03-29",
"last_updated": "2025-06-17",
"certification_date": "2025-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "125.085688",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "securerecords.sanford.html",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"address_1": "4600 N Ravenswood Ave",
"city": "Chicago",
"state": "IL",
"country_code": "US",
"postal_code": "606404510",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.