Provider Demographics
NPI:1619107968
Name:AHUJA, RENO KUMARI (MD)
Entity Type:Individual
Prefix:
First Name:RENO
Middle Name:KUMARI
Last Name:AHUJA
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 1:4230 LINCOLNSHIRE DR STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2189
Mailing Address - Country:US
Mailing Address - Phone:618-315-6466
Mailing Address - Fax:866-755-6173
Practice Address - Street 1:4230 LINCOLNSHIRE DR STE A
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2189
Practice Address - Country:US
Practice Address - Phone:618-315-6466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1418612084P0800X
IL036.1283482084P0800X
IL036-1283482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6498001Medicare UPIN