Provider Demographics
NPI:1033613831
Name:RAJAH, BAVANI WANAR (MD)
Entity type:Individual
Prefix:
First Name:BAVANI
Middle Name:WANAR
Last Name:RAJAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LAKE ST STE 616
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:614-591-3934
Practice Address - Street 1:1010 LAKE ST STE 616
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1136
Practice Address - Country:US
Practice Address - Phone:312-640-7740
Practice Address - Fax:614-591-3934
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1563132084P0800X
IL10336138312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry