Provider Demographics
NPI:1164650248
Name:KANJAMA, THEODORA K (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORA
Middle Name:K
Last Name:KANJAMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 CLYDE DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-1308
Mailing Address - Country:US
Mailing Address - Phone:630-536-7733
Mailing Address - Fax:
Practice Address - Street 1:1552 CLYDE DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1308
Practice Address - Country:US
Practice Address - Phone:630-536-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036140982207R00000X, 208M00000X
FLME112240207R00000X
IL036.140982208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine