Provider Demographics
NPI:1477583227
Name:RAO, VIKRAM (MD)
Entity Type:Individual
Prefix:
First Name:VIKRAM
Middle Name:
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 1:8367 MISTY MDWS
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7427
Mailing Address - Country:US
Mailing Address - Phone:810-953-2443
Mailing Address - Fax:810-953-1453
Practice Address - Street 1:11995 SINGLETREE LN STE 500
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5349
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010676272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4372111Medicaid
MI4451331Medicaid
MI4372130Medicaid
MI4372149Medicaid
MI4451331Medicaid
MIG12346Medicare UPIN
MI4372149Medicaid
MI0B56078029Medicare ID - Type Unspecified