Provider Demographics
NPI:1508861691
Name:RAO, NAGULAPALLI S (MD)
Entity Type:Individual
Prefix:
First Name:NAGULAPALLI
Middle Name:S
Last Name:RAO
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 1:1 ERIE CT
Mailing Address - Street 2:STE 7160
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2510
Mailing Address - Country:US
Mailing Address - Phone:708-386-4487
Mailing Address - Fax:708-386-4459
Practice Address - Street 1:1 ERIE CT
Practice Address - Street 2:STE 7160
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2510
Practice Address - Country:US
Practice Address - Phone:708-386-4487
Practice Address - Fax:708-386-4459
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36046296174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21604882OtherBLUE CROSS BLUE SHIELD
ILD12758Medicare UPIN
ILK36233Medicare ID - Type Unspecified