MEDICARE: RAJEEV PRABAKARAN 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	207RG0100X	Gastroenterology Physician	ME 118881	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	K7665	OTHER	FL	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HW302Z	OTHER	FL	MEIDCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	14UW9	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1366618209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJEEV PRABAKARAN MD

Provider Business Mailing Address
First Line	:	311 9TH ST N STE 304
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-5887
Country	:	US
Telephone Number	:	239-624-2730
Fax Number	:	239-624-2731

Provider Business Practice Location Address
First Line	:	311 9TH ST N STE 304
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-5887
Country	:	US
Telephone Number	:	239-624-2730
Fax Number	:	239-624-2731

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

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	09/01/2017

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Directions to “ RAJEEV PRABAKARAN MD” Practice Location

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