Healthcare Provider Details

I. General information

NPI: 1114116134
Provider Name (Legal Business Name): R.K. NATESH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 02/09/2011
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 Code208600000X
TaxonomySurgery Physician
License Number036084014
License Number StateIL

VIII. Authorized Official

Name: MS. MARIANNE LOWE
Title or Position: BILLER
Credential:
Phone: 708-534-2168