Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 51563 | KY |
N | 207T00000X | Neurosurgeon | A146390 | CA |
NPI | 1053636241 |
---|---|
Provider Name | Abigail Justine Rao |
First Address | Chicago, IL 60677-6351 |
Second Address | Louisville, KY 40241-2847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2010 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100569370 | (05) | KY |
K270630 | MEDICARE (01) | KY |