Provider Demographics
NPI:1679504682
Name:RAJASEKHAR, R (MD SC)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:
Last Name:RAJASEKHAR
Suffix:
Gender:M
Credentials:MD SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4689
Mailing Address - Country:US
Mailing Address - Phone:773-777-1100
Mailing Address - Fax:773-777-8409
Practice Address - Street 1:7030 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4689
Practice Address - Country:US
Practice Address - Phone:773-777-1100
Practice Address - Fax:773-777-8409
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049834174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036049834Medicaid
IL601010Medicare ID - Type Unspecified