Healthcare Provider Details

I. General information

NPI: 1508908674
Provider Name (Legal Business Name): C.B. RAO, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LAKE SHORE DR
ISHPEMING MI
49849-1367
US

IV. Provider business mailing address

2837 US HIGHWAY 41 W
MARQUETTE MI
49855-2252
US

V. Phone/Fax

Practice location:
  • Phone: 906-485-5583
  • Fax:
Mailing address:
  • Phone: 906-225-3964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301039874
License Number StateMI

VIII. Authorized Official

Name: CHINTAMENI B RAO
Title or Position: OWNER
Credential: M.D.
Phone: 906-488-5583