Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 036052004 | IL |
NPI | 1285630079 |
---|---|
Provider Name | Dr. Rajendra M. Choksi |
First Address | Woodridge, IL 60517-1437 |
Second Address | Joliet, IL 60432-4009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2005 |
Last Update Date | 08/07/2007 |