Healthcare Provider Details

I. General information

NPI: 1568584506
Provider Name (Legal Business Name): SANJAY N RAO MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 S FEDERAL ST E
CHICAGO IL
60605-3060
US

IV. Provider business mailing address

1426 S FEDERAL ST E
CHICAGO IL
60605-3060
US

V. Phone/Fax

Practice location:
  • Phone: 847-668-5498
  • Fax: 312-765-0409
Mailing address:
  • Phone: 847-668-5498
  • Fax: 312-765-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. SANJAY NAGULAPALLI RAO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-668-5498