MEDICARE: RICARDO RAO MD

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	2086S0129X	Vascular Surgery Physician	R3J01	MO

General Provider Information

NPI Number	:	1427029362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO RAO MD

Provider Business Mailing Address
First Line	:	PO BOX 790056
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63179-0056
Country	:	US
Telephone Number	:	314-989-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3023 N BALLAS RD
Second Line	:	SUITE 210D
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2330
Country	:	US
Telephone Number	:	314-993-9229
Fax Number	:	314-993-8398

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	06/27/2014

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