Healthcare Provider Details

I. General information

NPI: 1366618209
Provider Name (Legal Business Name): RAJEEV PRABAKARAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 09/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 9TH ST N STE 304
NAPLES FL
34102-5887
US

IV. Provider business mailing address

311 9TH ST N STE 304
NAPLES FL
34102-5887
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-2730
  • Fax: 239-624-2731
Mailing address:
  • Phone: 239-624-2730
  • Fax: 239-624-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME 118881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: