Provider Demographics
NPI:1629054606
Name:PATWARI, RAJANI GAJANAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJANI
Middle Name:GAJANAN
Last Name:PATWARI
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 1:100 GOUGAR RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-9787
Mailing Address - Country:US
Mailing Address - Phone:708-283-3018
Mailing Address - Fax:
Practice Address - Street 1:100 GOUGAR RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-9787
Practice Address - Country:US
Practice Address - Phone:708-283-3018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-060237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD16025Medicare UPIN