Provider Demographics
NPI:1972771848
Name:RAJ, ANSHU ANISH (MD)
Entity type:Individual
Prefix:
First Name:ANSHU
Middle Name:ANISH
Last Name:RAJ
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 1:9955 KARLOV AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1117
Mailing Address - Country:US
Mailing Address - Phone:847-677-1122
Mailing Address - Fax:847-677-7382
Practice Address - Street 1:9955 KARLOV AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1117
Practice Address - Country:US
Practice Address - Phone:847-677-1122
Practice Address - Fax:847-677-7382
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104375207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104375Medicaid
IL036104375Medicaid