Healthcare Provider Details

I. General information

NPI: 1144807181
Provider Name (Legal Business Name): RAHUL DEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

21 MARION LN
WOODBRIDGE CT
06525-2046
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-6730
  • Fax:
Mailing address:
  • Phone: 203-815-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01088998A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: