Healthcare Provider Details

I. General information

NPI: 1336310572
Provider Name (Legal Business Name): RAJENDER REDDY CHERUKU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2008
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SW 73RD ST
SOUTH MIAMI FL
33143-4679
US

IV. Provider business mailing address

6200 SW 73RD ST BOX # 69
SOUTH MIAMI FL
33143-4679
US

V. Phone/Fax

Practice location:
  • Phone: 786-662-5465
  • Fax:
Mailing address:
  • Phone: 786-662-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME100742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: