Provider Demographics
NPI:1447229885
Name:RAO, GOPAL S (MD)
Entity Type:Individual
Prefix:DR
First Name:GOPAL
Middle Name:S
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 BIESTERFIELD RD STE 625
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3362
Mailing Address - Country:US
Mailing Address - Phone:847-981-6061
Mailing Address - Fax:872-241-0118
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 705A
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-981-6061
Practice Address - Fax:847-981-6062
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03610900Medicaid
ILP00686557OtherRR MEDICARE
ILR00171OtherMEDICARE PTAN
IL03610900Medicaid