Healthcare Provider Details

I. General information

NPI: 1407803794
Provider Name (Legal Business Name): RAJIVE K ADLAKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 W LINCOLN HWY
CROWN POINT IN
46307-9526
US

IV. Provider business mailing address

PO BOX 783
SCHERERVILLE IN
46375
US

V. Phone/Fax

Practice location:
  • Phone: 219-864-9494
  • Fax: 219-864-9595
Mailing address:
  • Phone: 219-864-9494
  • Fax: 219-864-9595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01049448A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036103384
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number01049448A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: