Basic Information
| Provider Information | |||||||||
| NPI: | 1699981365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAJESH | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | VISWAMBHARAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865303150 | ||||||||
| FaxNumber: | 7865303150 | ||||||||
| Practice Location | |||||||||
| Address1: | 6326 CERMAK RD | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604022304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083039234 | ||||||||
| FaxNumber: | 7083039250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036121300 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 065416 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.