Provider Demographics
NPI:1578742268
Name:RAO, MADHAV VIJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHAV
Middle Name:VIJAY
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:210 S DESPLAINES ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5500
Mailing Address - Country:US
Mailing Address - Phone:773-654-2700
Mailing Address - Fax:773-654-9930
Practice Address - Street 1:3002 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3012
Practice Address - Country:US
Practice Address - Phone:312-654-2701
Practice Address - Fax:773-296-3002
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2021-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL36115306207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR01649Medicare PIN