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General NPI Number Information
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NPI Number | 1821031816
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Entity Type | Individual
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Provider Name | MURALIDHARA G RAO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | 4101 S 4TH ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-5014
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Country | US
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Telephone | 913-682-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 3125 LAKEVIEW CIR
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City | LEAVENWORTH
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State | KS
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Zip | 66048-4972
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Country | US
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Telephone | 913-651-5597
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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 | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 04-18161
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License Number State | KS
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