MEDICARE: NAGULAPALLI S RAO MD

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	174400000X	Specialist	36046296	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21604882	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1508861691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAGULAPALLI S RAO MD

Provider Business Mailing Address
First Line	:	1 ERIE CT
Second Line	:	STE 7160
City	:	OAK PARK
State	:	IL
Zip	:	60302-2510
Country	:	US
Telephone Number	:	708-386-4487
Fax Number	:	708-386-4459

Provider Business Practice Location Address
First Line	:	1 ERIE CT
Second Line	:	STE 7160
City	:	OAK PARK
State	:	IL
Zip	:	60302-2510
Country	:	US
Telephone Number	:	708-386-4487
Fax Number	:	708-386-4459

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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Directions to “ NAGULAPALLI S RAO MD” Practice Location

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