Basic Information
| Provider Information | |||||||||
| NPI: | 1104935147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGARAJ | ||||||||
| FirstName: | RAJ | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 775985 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606775985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177706900 | ||||||||
| FaxNumber: | 3177706911 | ||||||||
| Practice Location | |||||||||
| Address1: | 395 WESTFIELD RD STE D | ||||||||
| Address2: | |||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460601425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177763520 | ||||||||
| FaxNumber: | 3177763522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 09/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 36098994 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RE0101X | 01060384A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 7247219 | 01 | AETNA | OTHER | P00235164 | 01 | RAILROAD MCARE PALAMETTO | OTHER | 000000365442 | 01 | ANTHEM | OTHER | 036098994 | 01 | IL | ILLINOIS PUBLIC AID | OTHER | 452665 | 01 | HEALTHLINK | OTHER | 6028300206 | 01 | CIGNA | OTHER | CG1979 | 01 | IN | RAILROAD MEDICARE | OTHER | 200517730L | 05 | IN | MEDICAID | 200517730X | 05 | IN | MEDICAID | N322359 | 01 | HARMONY HEALTH PLAN IND | OTHER | 351904269175 | 01 | CARESOURCE MEDICAID | OTHER | 200517730T | 05 | IN | MEDICAID | 351904269196 | 01 | CARESOURCE MEDICAID | OTHER |