Provider Demographics
NPI:1932140472
Name:RATHI, SAPNA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SAPNA
Middle Name:S
Last Name:RATHI
Suffix:
Gender:F
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 S VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-5826
Mailing Address - Country:US
Mailing Address - Phone:815-356-9371
Mailing Address - Fax:815-356-9428
Practice Address - Street 1:1 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-5826
Practice Address - Country:US
Practice Address - Phone:815-356-9371
Practice Address - Fax:815-356-9428
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087920208100000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05623778OtherBCBS
IL05623778OtherBCBS
ILK20136Medicare ID - Type Unspecified
ILK40427Medicare PIN
P00477199Medicare PIN
ILG28401Medicare UPIN