Provider Demographics
NPI:1447202288
Name:SOOD, RAJEEV (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJEEV
Middle Name:
Last Name:SOOD
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:PO BOX 2157
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-2157
Mailing Address - Country:US
Mailing Address - Phone:321-229-5564
Mailing Address - Fax:407-901-3623
Practice Address - Street 1:6735 CONROY RD
Practice Address - Street 2:SUITE 223
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3565
Practice Address - Country:US
Practice Address - Phone:321-229-5564
Practice Address - Fax:407-901-3623
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74999207R00000X
FLME0074999174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255388100Medicaid
FL43412Medicare PIN
FL43412UMedicare PIN