Provider Demographics
NPI:1104935147
Name:NAGARAJ, RAJ N (MD)
Entity type:Individual
Prefix:
First Name:RAJ
Middle Name:N
Last Name:NAGARAJ
Suffix:
Gender:M
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:PO BOX 775985
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5985
Mailing Address - Country:US
Mailing Address - Phone:317-770-6900
Mailing Address - Fax:317-770-6911
Practice Address - Street 1:395 WESTFIELD RD STE D
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1425
Practice Address - Country:US
Practice Address - Phone:317-776-3520
Practice Address - Fax:317-776-3522
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36098994207RE0101X
IN01060384A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
7247219OtherAETNA
P00235164OtherRAILROAD MCARE PALAMETTO
000000365442OtherANTHEM
IL036098994OtherILLINOIS PUBLIC AID
452665OtherHEALTHLINK
6028300206OtherCIGNA
INCG1979OtherRAILROAD MEDICARE
IN200517730LMedicaid
IN200517730XMedicaid
N322359OtherHARMONY HEALTH PLAN IND
351904269175OtherCARESOURCE MEDICAID
IN200517730TMedicaid
351904269196OtherCARESOURCE MEDICAID
IN859910EEEEMedicare PIN
IN192770AAAAMedicare PIN
IN200517730TMedicaid
IN780920IIMedicare PIN
H27173Medicare UPIN