Healthcare Provider Details

I. General information

NPI: 1053575597
Provider Name (Legal Business Name): MANIKANDAN RAJAGOPAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

IV. Provider business mailing address

2710 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-8000
  • Fax: 479-338-2383
Mailing address:
  • Phone: 479-338-8000
  • Fax: 479-338-2383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-8770
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-8770
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: