Active NPI
Mallikarjuna R Kanneganti, M.D.
- Psychiatric Hospital
- North Chicago, IL
National Provider Identifier
1760642482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric Hospital
- License
- 036078018
- Practice address
- 3001 Green Bay Rd
North Chicago, IL 60064-3048 - Phone
- (224) 610-3719
- Fax
- (224) 610-3824
- NPI assigned
- Jun 16, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatric Hospital | 283Q00000X | 036078018 | IL | Primary |
Addresses
Primary practice location
3001 Green Bay Rd
North Chicago, IL 60064-3048
Mailing address
3001 Green Bay Rd
North Chicago, IL 60064-3048
Phone (224) 610-3719
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213747200000",
"number": "1760642482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3001 GREEN BAY RD",
"city": "NORTH CHICAGO",
"state": "IL",
"postal_code": "600643048",
"telephone_number": "224-610-3719",
"fax_number": "224-610-3824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 GREEN BAY RD",
"city": "NORTH CHICAGO",
"state": "IL",
"postal_code": "600643048",
"telephone_number": "224-610-3719",
"fax_number": "224-610-3824"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANNEGANTI",
"first_name": "MALLIKARJUNA",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-16",
"last_updated": "2008-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "283Q00000X",
"taxonomy_group": "",
"desc": "Psychiatric Hospital",
"state": "IL",
"license": "036078018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.