Healthcare Provider Details

I. General information

NPI: 1306100375
Provider Name (Legal Business Name): RAKESH GADDAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5358 E BASELINE RD
MESA AZ
85206-4716
US

IV. Provider business mailing address

5358 E BASELINE RD
MESA AZ
85206-4716
US

V. Phone/Fax

Practice location:
  • Phone: 602-748-9187
  • Fax: 602-748-9187
Mailing address:
  • Phone: 602-748-9187
  • Fax: 602-748-9187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50089
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number50089
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: