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NPI Code Detail

MEDICARE: BHARAT RAJU M.D.

MEDICARE: BHARAT RAJU M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician35.099710OH

General Provider Information

NPI Number : 1720217581
Entity Type Code : Individual
Provider Name (Legal Business Name) : BHARAT RAJU M.D.
Provider Business Mailing Address
First Line : 7702 OAK RIDGE CT
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60012-1600
Country : US
Telephone Number : 815-404-9628
Fax Number :
Provider Business Practice Location Address
First Line : 2345 PHILADELPHIA DR
Second Line :
City : DAYTON
State : OH
Zip : 45406-1816
Country : US
Telephone Number : 937-276-4141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2009
Last Update Date : 05/02/2013

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