MEDICARE: RADHIKA RAWAL D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019.030239	IL

General Provider Information

NPI Number	:	1427431832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RADHIKA RAWAL D.D.S.

Provider Business Mailing Address
First Line	:	350 N CLARK ST FL 6
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-4712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7345 W 25TH ST
Second Line	:
City	:	NORTH RIVERSIDE
State	:	IL
Zip	:	60546-1409
Country	:	US
Telephone Number	:	708-447-0900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	07/02/2015

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