Healthcare Provider Details

I. General information

NPI: 1205802071
Provider Name (Legal Business Name): REKHA AGRAWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S FIRST AVE MAGUIRE CENTER, RM 3307
MAYWOOD IL
60153
US

IV. Provider business mailing address

2160 S FIRST AVE MAGUIRE CENTER, RM 3307
MAYWOOD IL
60153
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-4403
  • Fax: 708-216-3375
Mailing address:
  • Phone: 708-216-4403
  • Fax: 708-216-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number36067580
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: