Healthcare Provider Details

I. General information

NPI: 1689815193
Provider Name (Legal Business Name): ATIF RAJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 11/24/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 S CONGRESS ST
RUSHVILLE IL
62681-1465
US

IV. Provider business mailing address

1200 SWEET AUDREY CT
DAYTON OH
45458-9704
US

V. Phone/Fax

Practice location:
  • Phone: 217-322-4321
  • Fax: 217-322-2546
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.141990
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301095610
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.095116
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: