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Organization
SUJATHA RAO M.D., P.C.
Active
Organization
SUJATHA RAO M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUJATHA A RAO M.D. (PRESIDENT)
(618) 529-0120
Entity
Organization
Contact information
Practice address
1390 HOPE DR, CARBONDALE, IL 62901-5306
(618) 529-0120
Mailing address
3255 CINNEBAR PT, CARBONDALE, IL 62901-5203
(618) 529-0120
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
036111928
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111928
—
IL
01
—
03932030
BLUE CROSS BLUE SHIELD IL
IL
Enumeration date
01/25/2007
Last updated
02/22/2012
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