Healthcare Provider Details

I. General information

NPI: 1245246065
Provider Name (Legal Business Name): RAJA CHATTERJI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 RANDALL RD UNIT B
SOUTH ELGIN IL
60177-3354
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-4419
US

V. Phone/Fax

Practice location:
  • Phone: 847-931-1813
  • Fax: 847-931-1861
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number036-090866
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: