Provider Demographics
NPI:1649291923
Name:RAO, KALPANA (PHD)
Entity type:Individual
Prefix:DR
First Name:KALPANA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7814
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-7005
Mailing Address - Country:US
Mailing Address - Phone:262-948-1000
Mailing Address - Fax:262-942-9374
Practice Address - Street 1:6123 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2927
Practice Address - Country:US
Practice Address - Phone:262-948-1000
Practice Address - Fax:262-942-9374
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1918-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI05632021OtherBLUE CROSS BLUE SHIELD
WI364493357010OtherBLUE CROSS BLUE SHIELD
WI6110476OtherUNITED HEALTHCARE
WI39655400Medicaid
WIS37873Medicare UPIN
WI39655400Medicaid