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General NPI Number Information
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NPI Number | 1841308830
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Entity Type | Individual
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Provider Name | BAO-LAN RAIKAR MD
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 200 S GREENLEAF ST STE E
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City | GURNEE
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State | IL
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Zip | 60031-3398
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Country | US
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Telephone | 800-991-6117
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Fax | 888-812-8191
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Provider Business Mailing Address
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Address Line | 3820 NORTHDALE BLVD STE 201
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City | TAMPA
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State | FL
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Zip | 33624-1893
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Country | US
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Telephone | 800-991-6117
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Fax | 888-812-8191
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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 | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | 39327-20
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A69461
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 39327-20
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35479
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 39327
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License Number State | WI
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