Provider Demographics
NPI:1679968531
Name:VERMA, RAJIV (DO)
Entity Type:Individual
Prefix:
First Name:RAJIV
Middle Name:
Last Name:VERMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 ROLLINS RD STE 1400
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1512
Mailing Address - Country:US
Mailing Address - Phone:847-866-7846
Mailing Address - Fax:847-356-8510
Practice Address - Street 1:7900 ROLLINS RD STE 1400
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1512
Practice Address - Country:US
Practice Address - Phone:847-866-7846
Practice Address - Fax:847-356-8510
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036150156207QS0010X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program