Provider Demographics
NPI:1376503045
Name:DEEPANKAR, RAHUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:
Last Name:DEEPANKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S KENNEDY DR STE 700
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-2639
Mailing Address - Country:US
Mailing Address - Phone:815-935-7532
Mailing Address - Fax:815-933-7495
Practice Address - Street 1:400 S KENNEDY DR STE 700
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2639
Practice Address - Country:US
Practice Address - Phone:815-935-7532
Practice Address - Fax:815-933-7495
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360659061Medicaid
IL0360659061Medicaid
IL0360659061Medicaid
ILK36901Medicare PIN