Healthcare Provider Details

I. General information

NPI: 1861507568
Provider Name (Legal Business Name): MADHAVI N RAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EXECUTIVE CT SUITE 3
SOUTH BARRINGTON IL
60010-9519
US

IV. Provider business mailing address

25 TELSER RD UNIT 1057
LAKE ZURICH IL
60047-3647
US

V. Phone/Fax

Practice location:
  • Phone: 847-756-4500
  • Fax: 847-756-4501
Mailing address:
  • Phone: 847-756-4500
  • Fax: 847-756-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036099167
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036099167
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036099167
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: