MEDICARE: DR. SANTOSH GOPAL RANE 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	207R00000X	Internal Medicine Physician	0101240621	VA
2	207RC0000X	Cardiovascular Disease Physician	17265	NV
3	207RC0001X	Clinical Cardiac Electrophysiology Physician	MD60476157	WA
4	207RC0001X	Clinical Cardiac Electrophysiology Physician	17265	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	NV	MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	17265	OTHER	NV	NEVADA MEDICAL LICENSE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649371915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANTOSH GOPAL RANE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 98978
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8978
Country	:	US
Telephone Number	:	702-216-3346
Fax Number	:	702-671-6883

Provider Business Practice Location Address
First Line	:	2911 N TENAYA WAY STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0488
Country	:	US
Telephone Number	:	702-805-5678
Fax Number	:	702-268-7605

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	09/08/2020

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Directions to “ DR. SANTOSH GOPAL RANE M.D.” Practice Location

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