Provider Demographics
NPI:1255596318
Name:SUBBA RAO MD SC
Entity type:Organization
Organization Name:SUBBA RAO MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBBA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-887-7073
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60522-0022
Mailing Address - Country:US
Mailing Address - Phone:630-887-7073
Mailing Address - Fax:630-887-9566
Practice Address - Street 1:17850 KEDZIE AVE
Practice Address - Street 2:SUITE 3000
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2058
Practice Address - Country:US
Practice Address - Phone:708-798-7878
Practice Address - Fax:630-887-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021606711OtherBLUE CROSS
IL036047207Medicaid
IL0021606711OtherBLUE CROSS
IL036047207Medicaid