Provider Demographics
NPI:1578753174
Name:RAO UPPULURI M.D.S.C.
Entity Type:Organization
Organization Name:RAO UPPULURI M.D.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-957-0220
Mailing Address - Street 1:17901 GOVERNORS HWY
Mailing Address - Street 2:202
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1144
Mailing Address - Country:US
Mailing Address - Phone:708-957-0220
Mailing Address - Fax:708-957-4519
Practice Address - Street 1:17901 GOVERNORS HWY
Practice Address - Street 2:202
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1144
Practice Address - Country:US
Practice Address - Phone:708-957-0220
Practice Address - Fax:708-957-4519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH34923Medicare UPIN
ILL85357Medicare PIN
ILD14268Medicare UPIN
ILL85356Medicare PIN