Provider Demographics
NPI:1285713669
Name:RAIGAGA, KUMAR B (DPM)
Entity type:Individual
Prefix:DR
First Name:KUMAR
Middle Name:B
Last Name:RAIGAGA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2357 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6222
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:
Practice Address - Street 1:2040 OGDEN AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7206
Practice Address - Country:US
Practice Address - Phone:630-585-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004923213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0727500009Medicare NSC
IL0727500002Medicare NSC