Healthcare Provider Details

I. General information

NPI: 1902813546
Provider Name (Legal Business Name): AARTI JAGDISH RAUT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 OAK PARK AVE
BERWYN IL
60402-3429
US

IV. Provider business mailing address

1400 W PARK ST
URBANA IL
61801-2334
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-9100
  • Fax: 708-783-2053
Mailing address:
  • Phone: 217-337-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036070024
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036070024
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberQ1002
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036070024
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: