Healthcare Provider Details

I. General information

NPI: 1518160720
Provider Name (Legal Business Name): RAJUL KOTHARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

602 N EAST AVE
OAK PARK IL
60302-1716
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-9874
  • Fax:
Mailing address:
  • Phone: 312-375-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036128285
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number01082843A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number036128285
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: