Healthcare Provider Details

I. General information

NPI: 1285713669
Provider Name (Legal Business Name): KUMAR B. RAIGAGA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 OGDEN AVE SUITE 401
AURORA IL
60504-7206
US

IV. Provider business mailing address

2357 SEQUOIA DR
AURORA IL
60506-6222
US

V. Phone/Fax

Practice location:
  • Phone: 630-585-7100
  • Fax:
Mailing address:
  • Phone: 630-859-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016004923
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: