MEDICARE: INNOVATIVE IV CARE, PLLC

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1457818098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE IV CARE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 25108
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-2002
Country	:	US
Telephone Number	:	773-270-5600
Fax Number	:	773-661-1821

Provider Business Practice Location Address
First Line	:	3221 N SHEFFIELD AVE STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-8510
Country	:	US
Telephone Number	:	773-270-5600
Fax Number	:	773-661-1821

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAHUL K KHARE
Credential	:	MD
Telephone Number	:	773-799-8520

Provider Enumeration Date	:	03/01/2019
Last Update Date	:	12/06/2022

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