Provider Demographics
NPI:1851465579
Name:RAICHAND, MOTILAL (M D)
Entity Type:Individual
Prefix:
First Name:MOTILAL
Middle Name:
Last Name:RAICHAND
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 HIGHLAND AVE
Mailing Address - Street 2:TOWER 1 SUITE 4 J
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1552
Mailing Address - Country:US
Mailing Address - Phone:630-971-8330
Mailing Address - Fax:
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:TOWER 1 SUITE 4 J
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-971-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL659063Medicare ID - Type Unspecified
ILC43001Medicare UPIN