Provider Demographics
NPI:1043207251
Name:MANJUNATH, RAJINI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJINI
Middle Name:
Last Name:MANJUNATH
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:PO BOX 25070
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-2150
Mailing Address - Country:US
Mailing Address - Phone:847-585-7000
Mailing Address - Fax:847-240-0622
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:STE 300
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9400
Practice Address - Country:US
Practice Address - Phone:847-931-0909
Practice Address - Fax:847-931-0939
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095233207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095233Medicaid
IL036095233Medicaid
ILF400115203Medicare PIN
ILF400115207Medicare PIN
ILH17436Medicare UPIN