Provider Demographics
NPI:1811420771
Name:HARADA, RAKUSHUMIMARIKA (MD)
Entity Type:Individual
Prefix:
First Name:RAKUSHUMIMARIKA
Middle Name:
Last Name:HARADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIKA
Other - Middle Name:
Other - Last Name:HARADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5555 E MOCKINGBIRD LN
Mailing Address - Street 2:APT 406
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5364
Mailing Address - Country:US
Mailing Address - Phone:469-520-0348
Mailing Address - Fax:
Practice Address - Street 1:5555 E MOCKINGBIRD LN
Practice Address - Street 2:APT 406
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5364
Practice Address - Country:US
Practice Address - Phone:469-520-0348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS8712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program