Rajyaguru, Prutha R

Rajyaguru, Prutha R is an individual health care provider with primary practice located at 12255 S 80Th Ave Ste 203 , Palos Heights IL 60463-1284. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Rajyaguru, Prutha R can be contacted via phone (708) 827-2021.

Contact Information

Primary practice address
12255 S 80Th Ave Ste 203 Palos Heights IL 60463-1284
Phone: (708) 827-2021
Fax: (708) 827-2241
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 53876 California
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 10004020A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085008524 Illinois

Profile Details

NPI number 1306396700
LBN Legal business name Rajyaguru, Prutha R
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 10th, 2016
Last updated Jun 5th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306396700 NPPES
Indiana Other 068010915 MEDICARE PTAN
Indiana MEDICAID 300077922 MEDICARE PTAN
Indiana Other 085008524 MEDICARE PTAN

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