Provider Demographics
NPI:1932499761
Name:RAO, YAMINI BEAR (MD)
Entity Type:Individual
Prefix:
First Name:YAMINI
Middle Name:BEAR
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3555 LUTHERAN PKWY
Mailing Address - Street 2:#340
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6021
Mailing Address - Country:US
Mailing Address - Phone:303-996-6005
Mailing Address - Fax:303-420-8831
Practice Address - Street 1:3555 LUTHERAN PKWY
Practice Address - Street 2:#340
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6021
Practice Address - Country:US
Practice Address - Phone:303-996-6005
Practice Address - Fax:303-420-8831
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR 0057248208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN