Provider Demographics
NPI:1184676371
Name:GHATE, RAJU (MD)
Entity Type:Individual
Prefix:
First Name:RAJU
Middle Name:
Last Name:GHATE
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 1:680 NORTH LAKE SHORE DRIVE
Mailing Address - Street 2:ATTN: LILLI KORNBLUM SUITE 1028
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2116
Mailing Address - Country:US
Mailing Address - Phone:312-475-5535
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE 1028
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-664-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-106509207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-106509Medicaid
ILK31586Medicare PIN
ILK31587Medicare PIN