Provider Demographics
NPI:1528008414
Name:SWAMINATHAN, RAJAGOPALA (MD)
Entity Type:Individual
Prefix:MR
First Name:RAJAGOPALA
Middle Name:
Last Name:SWAMINATHAN
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 1:3024 E EMPIRE ST STE E
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-5402
Mailing Address - Country:US
Mailing Address - Phone:309-451-3376
Mailing Address - Fax:309-452-3376
Practice Address - Street 1:3024 E EMPIRE ST STE EANDF
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-5402
Practice Address - Country:US
Practice Address - Phone:309-451-3376
Practice Address - Fax:309-452-3376
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052561207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004006893OtherAETNA
036052561001OtherOSF HEALTHPLANS INC
37122730101OtherJOHN DEERE HEALTH CARE
070002088OtherRAILROAD MEDICARE
3712273010002OtherCIGNA HEALTHCARE
IL563285OtherHEALTHLINK
IL7200602OtherBLUE CROSS BLUE SHIELD IL
C619811OtherUNITED AMER INSURANCE CO
IL7200602OtherBLUE CROSS BLUE SHIELD IL