Healthcare Provider Details

I. General information

NPI: 1326264177
Provider Name (Legal Business Name): RADHAKRISHNA K. RAO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 W. SAINT ISABEL STREET SUITE A
TAMPA FL
33607-6380
US

IV. Provider business mailing address

2508 W. SAINT ISABEL STREET SUITE A
TAMPA FL
33607-6380
US

V. Phone/Fax

Practice location:
  • Phone: 813-876-3783
  • Fax: 813-876-2525
Mailing address:
  • Phone: 813-876-3783
  • Fax: 813-876-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME63971
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: