MEDICARE: PRATIBHA RASTOGI 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	207L00000X	Anesthesiology Physician	036081961	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27-4170061	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831189588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRATIBHA RASTOGI MD

Provider Business Mailing Address
First Line	:	PO BOX 660832
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0832
Country	:	US
Telephone Number	:	972-715-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	13601 PRESTON RD
Second Line	:	SUITE 1000 W
City	:	DALLAS
State	:	TX
Zip	:	75240-4911
Country	:	US
Telephone Number	:	972-715-5007
Fax Number	:	972-715-5682

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	04/16/2013

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