Provider Demographics
NPI:1598791170
Name:RAJU, JAYASHREE R (DO)
Entity Type:Individual
Prefix:
First Name:JAYASHREE
Middle Name:R
Last Name:RAJU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 W ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-1587
Mailing Address - Country:US
Mailing Address - Phone:847-221-2900
Mailing Address - Fax:847-221-5900
Practice Address - Street 1:1626 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-1587
Practice Address - Country:US
Practice Address - Phone:847-221-2900
Practice Address - Fax:847-221-5900
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3041207R00000X
IL036090272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG18888Medicare UPIN
AZG18888Medicare UPIN