Provider Demographics
NPI:1548217086
Name:NATESH, RUPA (MD)
Entity type:Individual
Prefix:DR
First Name:RUPA
Middle Name:
Last Name:NATESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 ESSINGTON RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8425
Mailing Address - Country:US
Mailing Address - Phone:815-725-2600
Mailing Address - Fax:815-725-2601
Practice Address - Street 1:1100 ESSINGTON RD
Practice Address - Street 2:SUITE 6
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8425
Practice Address - Country:US
Practice Address - Phone:815-725-2600
Practice Address - Fax:815-725-2601
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084279Medicaid