Provider Demographics
NPI:1013366293
Name:MAHTANI, RAJ
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:
Last Name:MAHTANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 ROSEHALL LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-8932
Mailing Address - Country:US
Mailing Address - Phone:773-663-1602
Mailing Address - Fax:847-483-2074
Practice Address - Street 1:1020 W GOLF RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1340
Practice Address - Country:US
Practice Address - Phone:847-413-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.333893163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL261474424OtherTAX ID