Provider Demographics
NPI:1245218312
Name:RAO, UPAMAKA S (MD)
Entity Type:Individual
Prefix:DR
First Name:UPAMAKA
Middle Name:S
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:
Practice Address - Street 1:7640 SYLVANIA AVE
Practice Address - Street 2:SUITE L
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9729
Practice Address - Country:US
Practice Address - Phone:567-455-5906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069273207Q00000X
OH35069498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2091427Medicaid
MIG55280Medicare UPIN
OHH134742Medicare PIN
MI5007486OtherAETNA
OH2091427Medicaid
WI231807Medicare Oscar/Certification
OH9310221Medicare PIN
MI700E86031OtherBCBS OF MICHIGAN
MIG55280Medicare UPIN
OHH134742Medicare PIN
MI05834OtherHEALTH PLAN OF MICHIGAN
MIE86031008Medicare PIN