Provider Demographics
NPI:1689815193
Name:RAJA, ATIF (MD)
Entity Type:Individual
Prefix:
First Name:ATIF
Middle Name:
Last Name:RAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SWEET AUDREY CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:238 S CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681-1465
Practice Address - Country:US
Practice Address - Phone:217-322-4321
Practice Address - Fax:217-322-2546
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.141990207Q00000X
MI4301095610207Q00000X
OH35.095116207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine