Provider Demographics
NPI:1336467018
Name:RAO, SURAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:SURAJ
Middle Name:
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 BISCAYNE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-9800
Mailing Address - Country:US
Mailing Address - Phone:305-571-0620
Mailing Address - Fax:305-576-8099
Practice Address - Street 1:21097 NE 27TH CT STE 100
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-792-0012
Practice Address - Fax:305-792-0030
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.133157207RC0000X
390200000X
FLME136640207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program