Provider Demographics
NPI:1568584506
Name:SANJAY N RAO MD LLC
Entity Type:Organization
Organization Name:SANJAY N RAO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:NAGULAPALLI
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-668-5498
Mailing Address - Street 1:1426 S FEDERAL ST
Mailing Address - Street 2:E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3060
Mailing Address - Country:US
Mailing Address - Phone:847-668-5498
Mailing Address - Fax:312-765-0409
Practice Address - Street 1:1426 S FEDERAL ST
Practice Address - Street 2:E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3060
Practice Address - Country:US
Practice Address - Phone:847-668-5498
Practice Address - Fax:312-765-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK22403Medicare ID - Type Unspecified
ILH16968Medicare UPIN