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General NPI Number Information
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NPI Number | 1992764625
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Entity Type | Individual
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Provider Name | RAJAKUMARI PRAKASH SELVARAJ M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 393 REMINGTON BLVD. SUITE 340
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3442
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Country | US
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Telephone | 630-759-9800
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Fax | 630-759-9858
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Provider Business Mailing Address
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Address Line | 363 REMINGTON BLVD. SUITE 340
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3442
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Country | US
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Telephone | 630-759-9800
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Fax | 630-759-9858
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036-105260
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License Number State | IL
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