Provider Demographics
NPI:1891748547
Name:MALHOTRA, RAJESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:
Last Name:MALHOTRA
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 1:17001 E LARKSPUR LN
Mailing Address - Street 2:APT # 3
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-2108
Mailing Address - Country:US
Mailing Address - Phone:405-808-0836
Mailing Address - Fax:405-808-0836
Practice Address - Street 1:17001 E LARKSPUR LN
Practice Address - Street 2:APT # 3
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-2108
Practice Address - Country:US
Practice Address - Phone:405-808-0836
Practice Address - Fax:405-808-0836
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21122207RN0300X
MN47349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100005370BMedicaid
OK100005370BMedicaid
OK231322305Medicare ID - Type Unspecified