Provider Demographics
NPI:1326264177
Name:RAO, RADHAKRISHNA K (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHAKRISHNA
Middle Name:K
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2508 W. SAINT ISABEL STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6380
Mailing Address - Country:US
Mailing Address - Phone:813-876-3783
Mailing Address - Fax:813-876-2525
Practice Address - Street 1:2508 W. SAINT ISABEL STREET
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6380
Practice Address - Country:US
Practice Address - Phone:813-876-3783
Practice Address - Fax:813-876-2525
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME639712084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375370100Medicaid
F87011Medicare UPIN
FL375370100Medicaid