Provider Demographics
NPI:1114186947
Name:KANTHI RAJU, D.O., P.A.
Entity Type:Organization
Organization Name:KANTHI RAJU, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:KANTHI
Authorized Official - Middle Name:P
Authorized Official - Last Name:RAJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-918-0170
Mailing Address - Street 1:PO BOX 1171
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-1171
Mailing Address - Country:US
Mailing Address - Phone:972-991-9950
Mailing Address - Fax:
Practice Address - Street 1:275 W CAMPBELL RD
Practice Address - Street 2:SUITE 430
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3601
Practice Address - Country:US
Practice Address - Phone:972-918-0170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK19052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH08134Medicare UPIN
TX00Z192Medicare PIN