Provider Demographics
NPI:1083684153
Name:RAO, KAVITA BAKTHAVATSALAM (MD)
Entity Type:Individual
Prefix:
First Name:KAVITA
Middle Name:BAKTHAVATSALAM
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4957 38TH AVENUE NORTH
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-2174
Mailing Address - Country:US
Mailing Address - Phone:727-525-0900
Mailing Address - Fax:727-525-9500
Practice Address - Street 1:4957 38TH AVENUE NORTH
Practice Address - Street 2:SUITE C
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2174
Practice Address - Country:US
Practice Address - Phone:727-525-0900
Practice Address - Fax:727-525-9500
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301072100207R00000X
FLME89679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277550600Medicaid
MI4596992-10Medicaid
MI4596992-10Medicaid