Provider Demographics
NPI:1972616530
Name:RAO, LEELA N (MD)
Entity Type:Individual
Prefix:
First Name:LEELA
Middle Name:N
Last Name:RAO
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 1:420 S SCHMIDT RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 S SCHMIDT RD
Practice Address - Street 2:SUITE 230
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4925
Practice Address - Country:US
Practice Address - Phone:630-312-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077974207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077974Medicaid
ILK36520OtherMEDICARE INDIV ID# FOR GROUP 205474
ILK36521OtherMEDICARE INDIV ID# FOR GROUP 208256
IL208256Medicare PIN
IL205474Medicare PIN
ILK36519OtherMEDICARE INDIV ID# FOR GROUP 336140
F56493Medicare UPIN
IL336140Medicare PIN
ILP00414314OtherMEDICARE RR