Provider Demographics
NPI:1487680005
Name:RATHOD, HARISHCHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:HARISHCHANDRA
Middle Name:
Last Name:RATHOD
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 1:10000 STIRLING RD STE 7
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8067
Mailing Address - Country:US
Mailing Address - Phone:954-589-5169
Mailing Address - Fax:954-589-5169
Practice Address - Street 1:10000 STIRLING RD STE 7
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8067
Practice Address - Country:US
Practice Address - Phone:954-589-5169
Practice Address - Fax:954-589-5169
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085833207Q00000X
IN01064877A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4752433Medicaid