Provider Demographics
NPI:1487629820
Name:GARG, RACHNA (MD)
Entity Type:Individual
Prefix:
First Name:RACHNA
Middle Name:
Last Name:GARG
Suffix:
Gender:F
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:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-0688
Mailing Address - Country:US
Mailing Address - Phone:815-464-1333
Mailing Address - Fax:815-464-8140
Practice Address - Street 1:9875 W LINCOLN HWY STE 104
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1934
Practice Address - Country:US
Practice Address - Phone:815-464-1333
Practice Address - Fax:815-464-8140
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39404207R00000X
IL036122119208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64121783Medicaid
KYP00317814OtherRRMCR
ILP00723356OtherRAILROAD MEDICARE
KYC72033OtherCUMBERLAND HEALTHCARE INC
KY030670000OtherBLACK LUNG
IL036122119Medicaid
KY61-1427889OtherCHA
KY61-1427889OtherUHC
IL05-0540914OtherTAX ID
KY61-1427889OtherBLUEGRASS FAMILY HEALTH
KY61-1427889OtherTRICARE
KY000000388141OtherANTHEM PROVIDER #
KY50009426OtherPASSPORT HEALTH PLAN
KY61-1427889OtherHUMANA
KYC72033OtherCUMBERLAND HEALTHCARE INC
KY61-1427889OtherCHA
KY0736543Medicare ID - Type Unspecified
KY64121783Medicaid