Provider Demographics
NPI:1750310454
Name:SOUNDARRAJAN, RADHA (MD)
Entity Type:Individual
Prefix:
First Name:RADHA
Middle Name:
Last Name:SOUNDARRAJAN
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 1:214 MCHENRY RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6748
Mailing Address - Country:US
Mailing Address - Phone:847-459-1160
Mailing Address - Fax:847-459-8692
Practice Address - Street 1:214 MCHENRY RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6748
Practice Address - Country:US
Practice Address - Phone:847-459-1160
Practice Address - Fax:847-459-8692
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL344130Medicare ID - Type Unspecified
ILF79219Medicare UPIN