Provider Demographics
NPI:1861507568
Name:RAO, MADHAVI N (MD)
Entity type:Individual
Prefix:DR
First Name:MADHAVI
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 1:25 TELSER RD
Mailing Address - Street 2:UNIT 1057
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3647
Mailing Address - Country:US
Mailing Address - Phone:847-756-4500
Mailing Address - Fax:847-756-4501
Practice Address - Street 1:4 EXECUTIVE CT
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9519
Practice Address - Country:US
Practice Address - Phone:847-756-4500
Practice Address - Fax:847-756-4501
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099167208D00000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203535OtherPTAN
IL20013381Medicaid
IL203536OtherPTAN
IL203537OtherPTAN
IL036099167Medicaid
IL203535OtherPTAN