Healthcare Provider Details

I. General information

NPI: 1548217086
Provider Name (Legal Business Name): RUPA NATESH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ESSINGTON RD SUITE 6
JOLIET IL
60435-8425
US

IV. Provider business mailing address

1100 ESSINGTON RD SUITE 6
JOLIET IL
60435-8425
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-2600
  • Fax: 815-725-2601
Mailing address:
  • Phone: 815-725-2600
  • Fax: 815-725-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036084279
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: