Healthcare Provider Details

I. General information

NPI: 1487652186
Provider Name (Legal Business Name): RAJU B RAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BIESTERFIELD RD SUITE 310
ELK GROVE VILLAGE IL
60007-3392
US

IV. Provider business mailing address

120 W 22ND ST STE 200
OAK BROOK IL
60523-1563
US

V. Phone/Fax

Practice location:
  • Phone: 847-952-9332
  • Fax: 847-952-9338
Mailing address:
  • Phone: 630-573-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036094683
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: