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General NPI Number Information
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NPI Number | 1063814861
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Entity Type | Individual
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Provider Name | SRIRAM RANGARAJAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 4106 W LAKE MARY BLVD STE 213
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City | LAKE MARY
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State | FL
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Zip | 32746-2403
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Country | US
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Telephone | 407-422-3790
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Fax | 407-425-4358
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Provider Business Mailing Address
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Address Line | 4106 W LAKE MARY BLVD STE 213
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City | LAKE MARY
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State | FL
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Zip | 32746-2403
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Country | US
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Telephone | 407-422-3790
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Fax | 407-425-4358
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036166978
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 036166978
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | ME170321
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License Number State | FL
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