=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326434937
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHIRAG RAJYAGURU
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2015
-----------------------------------------------------
Last Update Date | 06/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13011 S 104TH AVE STE 100
-----------------------------------------------------
City | PALOS PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60464-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-478-3600
-----------------------------------------------------
Fax | 708-478-3552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13011 S 104TH AVE STE 100
-----------------------------------------------------
City | PALOS PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60464-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-478-3600
-----------------------------------------------------
Fax | 708-478-3552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 036157239
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 02006697A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207RA0001X
-----------------------------------------------------
Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
-----------------------------------------------------
License Number | 02006697A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207RA0001X
-----------------------------------------------------
Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
-----------------------------------------------------
License Number | 036.157239
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------