Healthcare Provider Details

I. General information

NPI: 1912085010
Provider Name (Legal Business Name): RAJU N PATURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 KAYS DRIVE SUITE B
NORMAL IL
61761
US

IV. Provider business mailing address

405 KAYS DRIVE SUITE B
NORMAL IL
61761
US

V. Phone/Fax

Practice location:
  • Phone: 309-862-0064
  • Fax: 309-862-1542
Mailing address:
  • Phone: 309-862-0064
  • Fax: 309-862-1542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: