MEDICARE: DR. RADHAKRISHNA K. 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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	ME63971	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

General Provider Information

NPI Number	:	1326264177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RADHAKRISHNA K. RAO M.D

Provider Business Mailing Address
First Line	:	2508 W. SAINT ISABEL STREET
Second Line	:	SUITE A
City	:	TAMPA
State	:	FL
Zip	:	33607-6380
Country	:	US
Telephone Number	:	813-876-3783
Fax Number	:	813-876-2525

Provider Business Practice Location Address
First Line	:	2508 W. SAINT ISABEL STREET
Second Line	:	SUITE A
City	:	TAMPA
State	:	FL
Zip	:	33607-6380
Country	:	US
Telephone Number	:	813-876-3783
Fax Number	:	813-876-2525

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	09/29/2008

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