Basic Information
| Provider Information | |||||||||
| NPI: | 1992764625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELVARAJ | ||||||||
| FirstName: | RAJAKUMARI | ||||||||
| MiddleName: | PRAKASH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 363 REMINGTON BLVD. | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604403442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307599800 | ||||||||
| FaxNumber: | 6307599858 | ||||||||
| Practice Location | |||||||||
| Address1: | 393 REMINGTON BLVD. | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604403442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307599800 | ||||||||
| FaxNumber: | 6307599858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 10/09/2008 | ||||||||
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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 | 207W00000X | 036-105260 | IL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.