Provider Demographics
NPI:1952523565
Name:RAJPUT, MOHAMED I (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:I
Last Name:RAJPUT
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 1:309 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231
Mailing Address - Country:US
Mailing Address - Phone:309-582-7283
Mailing Address - Fax:309-582-2667
Practice Address - Street 1:309 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231
Practice Address - Country:US
Practice Address - Phone:309-582-7283
Practice Address - Fax:309-582-2667
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053130208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053130Medicaid
C37640Medicare UPIN