MEDICARE: DR. RAJIVI POTHIRAJ RUCKER 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	208000000X	Pediatrics Physician	ME84160	FL
2	207K00000X	Allergy & Immunology Physician	ME84160	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	KI170	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48958	OTHER	FL	FL BLUE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194721522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJIVI POTHIRAJ RUCKER M.D.

Provider Business Mailing Address
First Line	:	1250 S TAMIAMI TRL STE 302
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-2221
Country	:	US
Telephone Number	:	941-877-5983
Fax Number	:	941-957-0079

Provider Business Practice Location Address
First Line	:	1250 S TAMIAMI TRL STE 302
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-2221
Country	:	US
Telephone Number	:	941-877-5983
Fax Number	:	941-957-0079

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/21/2020

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Directions to “ DR. RAJIVI POTHIRAJ RUCKER M.D.” Practice Location

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