Healthcare Provider Details

I. General information

NPI: 1295197705
Provider Name (Legal Business Name): RAKESH KANIPAKAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 CHESTNUT ST
MONTGOMERY AL
36106-1111
US

IV. Provider business mailing address

2034 CHESTNUT ST
MONTGOMERY AL
36106-1111
US

V. Phone/Fax

Practice location:
  • Phone: 334-269-0212
  • Fax: 334-269-2144
Mailing address:
  • Phone: 334-269-0212
  • Fax: 334-269-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD.46579
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: