Provider Demographics
NPI:1811967730
Name:RAO, VIJAYKUMAR (MD)
Entity type:Individual
Prefix:
First Name:VIJAYKUMAR
Middle Name:
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 S DESPLAINES ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5500
Mailing Address - Country:US
Mailing Address - Phone:312-654-2700
Mailing Address - Fax:312-654-9930
Practice Address - Street 1:17225 PAXTON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3757
Practice Address - Country:US
Practice Address - Phone:708-474-8700
Practice Address - Fax:708-474-9730
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036058283207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058283Medicaid
C43579Medicare UPIN
ILP03271Medicare PIN