Provider Demographics
NPI:1083623581
Name:RAJU, SATYANARAYANA GANAPATHI (DO, PHD)
Entity Type:Individual
Prefix:DR
First Name:SATYANARAYANA
Middle Name:GANAPATHI
Last Name:RAJU
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3718
Mailing Address - Country:US
Mailing Address - Phone:217-442-3010
Mailing Address - Fax:217-442-3155
Practice Address - Street 1:806 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3718
Practice Address - Country:US
Practice Address - Phone:217-442-3010
Practice Address - Fax:217-442-3155
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002114A207Q00000X
IL036-1075102081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine