Provider Demographics
NPI:1073043352
Name:RAJANI, JACKIE RAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:RAJ
Last Name:RAJANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 E SCRANTON AVE
Mailing Address - Street 2:UNIT 115
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-3204
Mailing Address - Country:US
Mailing Address - Phone:847-578-8711
Mailing Address - Fax:
Practice Address - Street 1:26 E SCRANTON AVE
Practice Address - Street 2:UNIT 115
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-3204
Practice Address - Country:US
Practice Address - Phone:847-578-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361502882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry