Healthcare Provider Details

I. General information

NPI: 1114143021
Provider Name (Legal Business Name): RASA LIESIONYTE KEDAINIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RASA LIESIONYTE M.D.

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE STE 140
AURORA IL
60504-5894
US

IV. Provider business mailing address

2020 OGDEN AVE STE 140
AURORA IL
60504-5894
US

V. Phone/Fax

Practice location:
  • Phone: 630-851-1144
  • Fax:
Mailing address:
  • Phone: 630-851-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036-112385
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2005014811
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: