Provider Demographics
NPI:1255325643
Name:SUNDAR RAO, CORINNE (MD)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:SUNDAR 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 1:120 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536
Mailing Address - Country:US
Mailing Address - Phone:417-533-6100
Mailing Address - Fax:
Practice Address - Street 1:201 NW R D MIZE RD STE 206
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2513
Practice Address - Country:US
Practice Address - Phone:816-655-5403
Practice Address - Fax:816-655-5257
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106490207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO008013557OtherMEDICARE PTAN
MO106490OtherLICENSE
MOP00244830OtherRAILROAD MEDICARE
MO205212608Medicaid
MO008013557OtherMEDICARE PTAN
MOP00244830OtherRAILROAD MEDICARE