MEDICARE: DR. KEVIN MICHAEL GOPALA RAO MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1356043046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN MICHAEL GOPALA RAO MD

Provider Business Mailing Address
First Line	:	777 GLADES RD
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-6496
Country	:	US
Telephone Number	:	561-297-4828
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 GLADES RD
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-6496
Country	:	US
Telephone Number	:	561-297-4828
Fax Number	:

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

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	04/27/2026

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