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General NPI Number Information
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NPI Number | 1396989976
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Entity Type | Individual
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Provider Name | ANITHA RAO M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/27/2009
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 5215 HOLY CROSS PKWY
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City | MISHAWAKA
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State | IN
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Zip | 46545-1469
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Country | US
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Telephone | 574-335-6450
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Fax |
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Provider Business Mailing Address
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Address Line | 2504 SEQUOIA PKWY
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City | ANN ARBOR
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State | MI
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Zip | 48103-2660
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Country | US
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Telephone | 419-283-7846
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Fax |
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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 | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number | 036.135675
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01086698A
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License Number State | IN
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