Provider Demographics
NPI:1679525828
Name:UPPAL, RAJ BAHADUR (MD)
Entity type:Individual
Prefix:DR
First Name:RAJ
Middle Name:BAHADUR
Last Name:UPPAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4543 CORKTREE RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-1121
Mailing Address - Country:US
Mailing Address - Phone:630-717-8644
Mailing Address - Fax:630-717-8645
Practice Address - Street 1:5000 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-202-5418
Practice Address - Fax:708-202-2490
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-100865207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH05284Medicare UPIN