Individual
DIVYA RAGHAVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
611 W PARK ST, CARLE FORUM, LL, URBANA, IL 61801-2500
(217) 383-3110
Mailing address
30N 1900 E 4R312, SALT LAKE CITY, UT 84132-0006
(801) 581-8193
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125061317
IL
207RN0300X
Nephrology Physician
Primary
9423487-1205
UT
Other
Enumeration date
08/31/2012
Last updated
11/12/2021
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