Provider Demographics
NPI:1821031816
Name:RAO, MURALIDHARA G (MD)
Entity Type:Individual
Prefix:DR
First Name:MURALIDHARA
Middle Name:G
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 1:3125 LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-4972
Mailing Address - Country:US
Mailing Address - Phone:913-651-5597
Mailing Address - Fax:
Practice Address - Street 1:4101 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5014
Practice Address - Country:US
Practice Address - Phone:913-682-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18161207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS26993021OtherBLUE SHIELD KANSAS CITY
KS442299OtherHEALTHLINK
KS7290108OtherAETNA
KS26993021OtherBLUE SHIELD KANSAS CITY
KSP00407488Medicare PIN
KS7290108OtherAETNA
H19563Medicare UPIN