Provider Demographics
NPI:1023388642
Name:RAI, ANUPA (MD)
Entity Type:Individual
Prefix:
First Name:ANUPA
Middle Name:
Last Name:RAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 S MICHIGAN AVE
Mailing Address - Street 2:APARTMENT 208
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4145
Mailing Address - Country:US
Mailing Address - Phone:630-865-9940
Mailing Address - Fax:
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:708-344-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125057304207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036132491Medicaid
ILF400111213OtherMEDICARE PTAN
IL125057304OtherTEMPORARY MEDICAL LICENCE