Provider Demographics
NPI:1083679963
Name:CHAVDA, RAJESHWARI (MD)
Entity Type:Individual
Prefix:
First Name:RAJESHWARI
Middle Name:
Last Name:CHAVDA
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:DEPT 4392
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4392
Mailing Address - Country:US
Mailing Address - Phone:866-540-5303
Mailing Address - Fax:724-502-4070
Practice Address - Street 1:800 W CENTRAL ROAD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:866-344-0543
Practice Address - Fax:866-344-3934
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36111699207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361116991Medicaid
IL0361116991Medicaid
ILP00249317Medicare PIN
ILK20004Medicare PIN
ILK11218Medicare ID - Type Unspecified