Provider Demographics
NPI:1437378569
Name:RAJASEKHAR, SMITHA
Entity Type:Individual
Prefix:
First Name:SMITHA
Middle Name:
Last Name:RAJASEKHAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N ELM ST
Mailing Address - Street 2:STE 123
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3634
Mailing Address - Country:US
Mailing Address - Phone:630-325-5709
Mailing Address - Fax:630-325-0388
Practice Address - Street 1:911 N ELM ST
Practice Address - Street 2:STE 123
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3634
Practice Address - Country:US
Practice Address - Phone:630-325-5709
Practice Address - Fax:630-325-0388
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL400280Medicare PIN
IL400280Medicare PIN