Provider Demographics
NPI:1992864086
Name:RAO, SANKU S (MD)
Entity Type:Individual
Prefix:
First Name:SANKU
Middle Name:S
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S 5TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5825
Mailing Address - Country:US
Mailing Address - Phone:580-234-0285
Mailing Address - Fax:580-234-0590
Practice Address - Street 1:330 S 5TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5825
Practice Address - Country:US
Practice Address - Phone:580-234-0285
Practice Address - Fax:580-234-0590
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK12331207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100014700AMedicaid
OK100014700AMedicaid
OK$$$$$$$$$Medicare PIN