Provider Demographics
NPI:1356756282
Name:MOHINDROO, RAUBY (DPM)
Entity type:Individual
Prefix:
First Name:RAUBY
Middle Name:
Last Name:MOHINDROO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N HAMMES AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6688
Mailing Address - Country:US
Mailing Address - Phone:630-921-6766
Mailing Address - Fax:586-573-0850
Practice Address - Street 1:210 N HAMMES AVE STE 103
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6688
Practice Address - Country:US
Practice Address - Phone:815-374-3668
Practice Address - Fax:815-714-6208
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002534213ES0103X
IL016.005752213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery