Healthcare Provider Details

I. General information

NPI: 1124415179
Provider Name (Legal Business Name): KRISHNA GOPARAJU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 EUREKA RD
ROSEVILLE CA
95661-3027
US

IV. Provider business mailing address

251 E HURON ST STE 16738
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 916-784-5626
  • Fax: 916-474-2201
Mailing address:
  • Phone: 312-926-5924
  • Fax: 312-926-6134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.145717
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA191015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: