Provider Demographics
NPI:1417229584
Name:RAJPUT MEDICAL CLINIC LTD
Entity Type:Organization
Organization Name:RAJPUT MEDICAL CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:IL
Authorized Official - Last Name:RAJPUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-582-7283
Mailing Address - Street 1:309 N.W. 2ND ST.
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231-1404
Mailing Address - Country:US
Mailing Address - Phone:309-582-7283
Mailing Address - Fax:309-582-2667
Practice Address - Street 1:309 N.W. 2ND ST.
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-1404
Practice Address - Country:US
Practice Address - Phone:309-582-7283
Practice Address - Fax:309-582-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053130208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC37640Medicare UPIN