MEDICARE: DR. SURENDAR GAJENDRA RAO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	EP10034290	TX
2	207Q00000X	Family Medicine Physician	62640-20	WI
3	208D00000X	General Practice Physician	ACN702	FL
4	208D00000X	General Practice Physician	ME136965	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134450869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURENDAR GAJENDRA RAO M.D.

Provider Business Mailing Address
First Line	:	14750 NW 77TH CT STE 100
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-1507
Country	:	US
Telephone Number	:	786-758-3152
Fax Number	:	786-441-2156

Provider Business Practice Location Address
First Line	:	3345 BURNS RD STE 302
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4321
Country	:	US
Telephone Number	:	561-622-7661
Fax Number	:	561-622-4651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2010
Last Update Date	:	10/20/2020

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