Provider Demographics
NPI:1700872041
Name:PRAKASH, RAJAT (MD)
Entity type:Individual
Prefix:DR
First Name:RAJAT
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2796
Mailing Address - Country:US
Mailing Address - Phone:219-424-1488
Mailing Address - Fax:219-267-1704
Practice Address - Street 1:2838 45TH ST STE A
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2905
Practice Address - Country:US
Practice Address - Phone:219-424-1488
Practice Address - Fax:219-267-1704
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01092811A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300097181Medicaid
IL036-086-830Medicaid
ILF72864Medicare UPIN
ILL86627Medicare PIN
ILL86626Medicare PIN