Provider Demographics
NPI:1770261562
Name:VIVEK RAJ LLC
Entity type:Organization
Organization Name:VIVEK RAJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:224-777-8034
Mailing Address - Street 1:415 W GOLF RD STE 26
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3923
Mailing Address - Country:US
Mailing Address - Phone:224-777-8034
Mailing Address - Fax:
Practice Address - Street 1:17351 MELFORD BLVD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4457
Practice Address - Country:US
Practice Address - Phone:240-548-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty