Individual
PRUTHA R RAJYAGURU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12255 S 80TH AVE STE 203, PALOS HEIGHTS, IL 60463-1284
(708) 827-2021
(708) 827-2241
Mailing address
12255 S 80TH AVE STE 203, PALOS HEIGHTS, IL 60463-1284
(708) 827-2021
(708) 827-2241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085008524
IL
363A00000X
Physician Assistant
10004020A
IN
363A00000X
Physician Assistant
53876
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010915
MEDICARE PTAN
IN
01
—
085008524
STATE LICENSE
IL
05
—
300077922
—
IN
Enumeration date
10/10/2016
Last updated
06/05/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us