1174702948 NPI number — DR. KARISHMA KAUR RAI M.D.

Table of content: DR. KARISHMA KAUR RAI M.D. (NPI 1174702948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174702948 NPI number — DR. KARISHMA KAUR RAI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAI
Provider First Name:
KARISHMA
Provider Middle Name:
KAUR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174702948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4440 SOUTH WEST 95TH STREET
Provider Second Line Business Mailing Address:
ADVOCATE CHRIST MEDICAL CENTER, MED STAFF ROOM 109 SO.
Provider Business Mailing Address City Name:
OAK LAWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-684-5195
Provider Business Mailing Address Fax Number:
708-684-2058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2825 CAPITOL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-6039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-887-0000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  37647 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: C170094 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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