Healthcare Provider Details
I. General information
NPI: 1669486635
Provider Name (Legal Business Name): VRAJ, LTD
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/28/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2315 E 93RD ST STE 237
CHICAGO IL
60617-3919
US
IV. Provider business mailing address
10547 MISTY HILL RD
ORLAND PARK IL
60462-7439
US
V. Phone/Fax
- Phone: 847-768-8925
- Fax:
- Phone: 219-852-0197
- Fax: 219-937-2195
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RP1001X |
| Taxonomy | Pulmonary Disease Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
NARESH
K
UPADHYAY
Title or Position: OWNER
Credential: MD
Phone: 219-852-0197