Provider Demographics
NPI:1164539094
Name:MARWAHA, RAKESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAKESH
Middle Name:
Last Name:MARWAHA
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 1:640 S WASHINGTON ST
Mailing Address - Street 2:STE 380
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6603
Mailing Address - Country:US
Mailing Address - Phone:630-527-6390
Mailing Address - Fax:630-527-6392
Practice Address - Street 1:640 S WASHINGTON ST
Practice Address - Street 2:STE 380
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6603
Practice Address - Country:US
Practice Address - Phone:630-527-6390
Practice Address - Fax:630-527-6392
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082683174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082683Medicaid
IL036083929Medicaid
IL036113282Medicaid
IL2228249OtherBCBS OF ILL. PROVIDER #
ILF29158Medicare UPIN
ILI20665Medicare UPIN
ILK03254Medicare ID - Type UnspecifiedKHURSHID