Healthcare Provider Details

I. General information

NPI: 1386840148
Provider Name (Legal Business Name): SHEETAL KHEDKAR RAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEETAL PRAKASH KHEDKAR M.D.

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 12/05/2023
Certification Date: 12/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W. TAYLOR ST. SUITE 3AA
CHICAGO IL
60612
US

IV. Provider business mailing address

1801 W TAYLOR ST STE 3AA
CHICAGO IL
60612-4795
US

V. Phone/Fax

Practice location:
  • Phone: 123-551-7003
  • Fax:
Mailing address:
  • Phone: 312-355-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.125059
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: