Provider Demographics
NPI:1194753491
Name:MALHOTRA, RAJEEV (MD)
Entity type:Individual
Prefix:DR
First Name:RAJEEV
Middle Name:
Last Name:MALHOTRA
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 1:4305 LONE TREE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9794
Mailing Address - Country:US
Mailing Address - Phone:630-800-1350
Mailing Address - Fax:630-241-1543
Practice Address - Street 1:4305 LONE TREE CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9794
Practice Address - Country:US
Practice Address - Phone:630-800-1350
Practice Address - Fax:630-241-1543
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360964112084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017576790002Medicaid
PA029523Medicare ID - Type UnspecifiedHGSA MEDICARE
PA0017576790002Medicaid