Healthcare Provider Details

I. General information

NPI: 1891748547
Provider Name (Legal Business Name): RAJESH MALHOTRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17001 E LARKSPUR LN APT # 3
INDEPENDENCE MO
64055-2108
US

IV. Provider business mailing address

17001 E LARKSPUR LN APT # 3
INDEPENDENCE MO
64055-2108
US

V. Phone/Fax

Practice location:
  • Phone: 405-808-0836
  • Fax: 405-808-0836
Mailing address:
  • Phone: 405-808-0836
  • Fax: 405-808-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47349
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number21122
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: