Healthcare Provider Details

I. General information

NPI: 1932311883
Provider Name (Legal Business Name): RENU R MAHAJAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MADISON ST STE 300
OAK PARK IL
60302-4210
US

IV. Provider business mailing address

231 N EUCLID AVE
OAK PARK IL
60302-2107
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6498
  • Fax: 312-996-4169
Mailing address:
  • Phone: 708-771-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number36117839
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: