Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036-090352 | IL |
Y | 111NI0900X | Internist | 036-090352 | IL |
N | 207RA0401X | Internist - Addiction Medicine | 036090352 | IL |
NPI | 1497866784 |
---|---|
Provider Name | Dr. Rajeswar Rajagopalan |
First Address | Chicago, IL 60674-3257 |
Second Address | Itasca, IL 60143-3128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 29/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G09921 | (02) | IL |