Provider Demographics
NPI:1821023714
Name:IYENGAR, RAJESH T (MD)
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:T
Last Name:IYENGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:36123 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1216
Mailing Address - Country:US
Mailing Address - Phone:734-793-6140
Mailing Address - Fax:865-560-8948
Practice Address - Street 1:400 E 41ST ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3071
Practice Address - Country:US
Practice Address - Phone:773-624-2660
Practice Address - Fax:708-844-1226
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2018-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-112541207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-112541Medicaid
ILI23039Medicare UPIN
IL036-112541Medicaid