Healthcare Provider Details

I. General information

NPI: 1144908542
Provider Name (Legal Business Name): ANIKET VIJAY RAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 MAIN ST
HOUSTON TX
77030-1502
US

IV. Provider business mailing address

6445 MAIN ST
HOUSTON TX
77030-1502
US

V. Phone/Fax

Practice location:
  • Phone: 832-547-9230
  • Fax:
Mailing address:
  • Phone: 832-547-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: