MEDICARE: DR. DHEERAJ KANHAYALAL RAINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	03697225	IL
2	2084P0800X	Psychiatry Physician	42071-020	WI
3	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	03697225	IL

General Provider Information

NPI Number	:	1881768950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DHEERAJ KANHAYALAL RAINA

Provider Business Mailing Address
First Line	:	2301 POPPY LN # B
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8009
Country	:	US
Telephone Number	:	847-420-4552
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 VIRGINIA AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3709
Country	:	US
Telephone Number	:	847-420-4552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	02/23/2023

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