Provider Demographics
NPI:1356420368
Name:RAO, SUJATHA ANASAPURAPU (MD)
Entity type:Individual
Prefix:DR
First Name:SUJATHA
Middle Name:ANASAPURAPU
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 1:3255 CINNEBAR PT
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5203
Mailing Address - Country:US
Mailing Address - Phone:618-303-2712
Mailing Address - Fax:
Practice Address - Street 1:3255 CINNEBAR PT STE 1
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5203
Practice Address - Country:US
Practice Address - Phone:618-303-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL201307515174400000X
IL036111928207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111928Medicaid
IL290880Medicare ID - Type UnspecifiedINSURANCE