Provider Demographics
NPI:1699861013
Name:GOGIA, RAJENDRA S (MD)
Entity type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:S
Last Name:GOGIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1124
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-1124
Mailing Address - Country:US
Mailing Address - Phone:847-296-6161
Mailing Address - Fax:847-574-7487
Practice Address - Street 1:1420 RENAISSANCE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1330
Practice Address - Country:US
Practice Address - Phone:847-296-6161
Practice Address - Fax:847-574-7487
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360923022081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG32351Medicare UPIN