Provider Demographics
NPI:1790738615
Name:RAO, SANJAY N (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:N
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16 KIMBERLEY CIR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1719
Mailing Address - Country:US
Mailing Address - Phone:708-636-9393
Mailing Address - Fax:708-636-2022
Practice Address - Street 1:6201 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3888
Practice Address - Country:US
Practice Address - Phone:708-636-9393
Practice Address - Fax:708-636-2022
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036102488207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102488Medicaid
IL036102488Medicaid
ILK22403Medicare ID - Type Unspecified