Healthcare Provider Details

I. General information

NPI: 1003830852
Provider Name (Legal Business Name): RAJU ZACHARIAH ABRAHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N WALL ST STE C400
KANKAKEE IL
60901-2942
US

IV. Provider business mailing address

500 N WALL ST STE C400
KANKAKEE IL
60901-2942
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-3814
  • Fax: 815-933-3846
Mailing address:
  • Phone: 815-933-3814
  • Fax: 815-933-3846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036085787
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036085787
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036-085787
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: