MEDICARE: KAVITA BAKTHAVATSALAM RAO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301072100	MI
2	207R00000X	Internal Medicine Physician	ME89679	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083684153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAVITA BAKTHAVATSALAM RAO M.D.

Provider Business Mailing Address
First Line	:	4957 38TH AVENUE NORTH
Second Line	:	SUITE C
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-2174
Country	:	US
Telephone Number	:	727-525-0900
Fax Number	:	727-525-9500

Provider Business Practice Location Address
First Line	:	4957 38TH AVENUE NORTH
Second Line	:	SUITE C
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-2174
Country	:	US
Telephone Number	:	727-525-0900
Fax Number	:	727-525-9500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	01/20/2014

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