Provider Demographics
NPI:1831133693
Name:MAHAJAN, DHEERAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:DHEERAJ
Middle Name:
Last Name:MAHAJAN
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 1:675 W NORTH AVE
Mailing Address - Street 2:SUITE 606
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1634
Mailing Address - Country:US
Mailing Address - Phone:708-681-7877
Mailing Address - Fax:800-801-6284
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 606
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-681-7877
Practice Address - Fax:800-801-6284
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106392Medicaid
ILH72777Medicare UPIN
ILK25035Medicare ID - Type Unspecified