Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 036056977 | IL |
NPI | 1104898907 |
---|---|
Provider Name | Ramesh Rao |
First Address | Yonkers, NY 10704-4107 |
Second Address | Niles, IL 60714-4520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 18/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D150817 | (02) |