Healthcare Provider Details

I. General information

NPI: 1104898907
Provider Name (Legal Business Name): RAMESH RAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 W TOUHY AVE
NILES IL
60714-4520
US

IV. Provider business mailing address

967 MCLEAN AVE SUITE 387
YONKERS NY
10704-4107
US

V. Phone/Fax

Practice location:
  • Phone: 914-237-6797
  • Fax: 914-206-4950
Mailing address:
  • Phone: 914-237-6797
  • Fax: 914-206-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number036056977
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: