Provider Demographics
NPI:1316919889
Name:GADAGKAR, RAJESHWARI MOHAN (MD)
Entity type:Individual
Prefix:MS
First Name:RAJESHWARI
Middle Name:MOHAN
Last Name:GADAGKAR
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 1:4101 JOHN DEERE ROAD
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6790
Mailing Address - Country:US
Mailing Address - Phone:309-765-1600
Mailing Address - Fax:309-765-1610
Practice Address - Street 1:4101 JOHN DEERE ROAD
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6790
Practice Address - Country:US
Practice Address - Phone:309-765-1600
Practice Address - Fax:309-765-1610
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32959207R00000X
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1197277Medicaid
IA32959OtherLIC NUMBER
IA1197277Medicaid
H09716Medicare UPIN