Provider Demographics
NPI:1114116134
Name:R.K. NATESH MD PC
Entity Type:Organization
Organization Name:R.K. NATESH MD PC
Other - Org Name:RAMANATHAPUR NATESHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-534-2168
Mailing Address - Street 1:1100 ESSINGTON RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8425
Mailing Address - Country:US
Mailing Address - Phone:815-725-2600
Mailing Address - Fax:815-725-2601
Practice Address - Street 1:1100 ESSINGTON RD
Practice Address - Street 2:SUITE 6
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8425
Practice Address - Country:US
Practice Address - Phone:815-725-2600
Practice Address - Fax:815-725-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084014208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09921473OtherBCBS
ILP00165337OtherMEDICARE RAILROAD
IL036084014Medicaid
IL09921473OtherBCBS