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General NPI Number Information
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NPI Number | 1053753608
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Entity Type | Individual
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Provider Name | RAGHAVENDRA RAO S SATHYANARAYANA RAO M.D
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Gender | Male
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 555 W MADISON ST APT 4302
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City | CHICAGO
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State | IL
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Zip | 60661-2532
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Country | US
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Telephone | 312-216-7157
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Fax |
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Provider Business Mailing Address
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Address Line | 836 W WELLINGTON AVE
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City | CHICAGO
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State | IL
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Zip | 60657-5147
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01080217A
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License Number State | IN
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