Provider Demographics
NPI:1407838204
Name:MALHOTRA, RABINDRA NATH (MD)
Entity Type:Individual
Prefix:
First Name:RABINDRA
Middle Name:NATH
Last Name:MALHOTRA
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 1:4121 FAIRVIEW AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2264
Mailing Address - Country:US
Mailing Address - Phone:630-852-0230
Mailing Address - Fax:630-852-0244
Practice Address - Street 1:4121 FAIRVIEW AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:630-852-0230
Practice Address - Fax:630-852-0244
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057516174400000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057516Medicaid
ILL03099Medicare ID - Type UnspecifiedPROVIDER ID NUMBER