Provider Demographics
NPI:1639337942
Name:CHATTERGOON, RAJESH (APN)
Entity Type:Individual
Prefix:MR
First Name:RAJESH
Middle Name:
Last Name:CHATTERGOON
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N ABERDEEN ST
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 N ABERDEEN ST
Practice Address - Street 2:SUITE 100B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1249
Practice Address - Country:US
Practice Address - Phone:312-733-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY591215-1163W00000X
IL209.010937363L00000X, 363LG0600X, 363LP2300X
IL041.409457163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care