Provider Demographics
NPI:1982762456
Name:NATH, RANJANA (MD)
Entity Type:Individual
Prefix:DR
First Name:RANJANA
Middle Name:
Last Name:NATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E CONGRESS PKWY
Mailing Address - Street 2:STE E
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6284
Mailing Address - Country:US
Mailing Address - Phone:815-477-1555
Mailing Address - Fax:
Practice Address - Street 1:350 E CONGRESS PKWY
Practice Address - Street 2:STE E
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6284
Practice Address - Country:US
Practice Address - Phone:815-477-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-096681208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096681 1Medicaid
WINATHRANOtherMERCYCARE INSURANCE
G82819Medicare UPIN
WINATHRANOtherMERCYCARE INSURANCE