Healthcare Provider Details

I. General information

NPI: 1013109164
Provider Name (Legal Business Name): JURAT SINGH RAJPAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 DEMPSTER ST SECOND FLOOR
PARK RIDGE IL
60068-1110
US

IV. Provider business mailing address

485 CHERRY ST
WINNETKA IL
60093-2610
US

V. Phone/Fax

Practice location:
  • Phone: 847-318-9330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number52036
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number036.134312
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: