Provider Demographics
NPI:1871565226
Name:RAJPUT, FARIDA (MD)
Entity type:Individual
Prefix:DR
First Name:FARIDA
Middle Name:
Last Name:RAJPUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 E KIMBERLY RD
Mailing Address - Street 2:STE 200
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722
Mailing Address - Country:US
Mailing Address - Phone:563-441-1998
Mailing Address - Fax:563-441-1729
Practice Address - Street 1:1351 E KIMBERLY RD
Practice Address - Street 2:STE 200
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722
Practice Address - Country:US
Practice Address - Phone:563-441-1998
Practice Address - Fax:563-441-1729
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA222762085R0001X
IL0360638782085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0091215830OtherBCBS ILLINOIS
IA0211433Medicaid
920002605OtherRR PROVIDER
IA0211433Medicaid
IA21143Medicare PIN