Individual
MAMTHA RAJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., M.A.
Contact information
Practice address
1725 W HARRISON ST STE 425, CHICAGO, IL 60612-3893
(312) 563-3000
Mailing address
1725 W HARRISON ST STE 425, CHICAGO, IL 60612-3893
(312) 563-3000
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
036166530
IL
208200000X
Plastic Surgery Physician
66577
CT
208200000X
Plastic Surgery Physician
MT210474
PA
Other
Enumeration date
05/03/2016
Last updated
09/28/2023
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