MEDICARE: RAJA C MADDIPOTI 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	174400000X	Specialist	036-082727	IL
2	207RC0000X	Cardiovascular Disease Physician	036082727	IL
3	207RC0000X	Cardiovascular Disease Physician	ME143903	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	060067999	OTHER	IL	RAILROAD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215019328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJA C MADDIPOTI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 26067
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84126-0067
Country	:	US
Telephone Number	:	239-624-0400
Fax Number	:	239-624-0464

Provider Business Practice Location Address
First Line	:	625 9TH ST N STE 201
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-8143
Country	:	US
Telephone Number	:	239-261-2000
Fax Number	:	239-261-2266

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	04/27/2022

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Directions to “ RAJA C MADDIPOTI M.D.” Practice Location

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