Provider Demographics
NPI:1952651382
Name:FERNANDO, RAJEEV RUBEN (MBBS)
Entity Type:Individual
Prefix:
First Name:RAJEEV
Middle Name:RUBEN
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 PLEASANT ST STE 414
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1408
Mailing Address - Country:US
Mailing Address - Phone:515-241-5700
Mailing Address - Fax:
Practice Address - Street 1:365 N JEFFERSON ST
Practice Address - Street 2:2712
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1226
Practice Address - Country:US
Practice Address - Phone:713-876-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP20041756207RC0000X
IAMD-43759207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease