Provider Demographics
NPI:1669806501
Name:NATARAJAN, KUMARAVEL (LAC)
Entity type:Individual
Prefix:MR
First Name:KUMARAVEL
Middle Name:
Last Name:NATARAJAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 BLAZING STAR RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3554
Mailing Address - Country:US
Mailing Address - Phone:224-578-1828
Mailing Address - Fax:
Practice Address - Street 1:152 HAWLEY ST
Practice Address - Street 2:#5
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3554
Practice Address - Country:US
Practice Address - Phone:224-578-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001102171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist