Provider Demographics
NPI:1134450869
Name:RAO, SURENDAR GAJENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:SURENDAR
Middle Name:GAJENDRA
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 1:14750 NW 77TH CT STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1507
Mailing Address - Country:US
Mailing Address - Phone:786-758-3152
Mailing Address - Fax:786-441-2156
Practice Address - Street 1:3345 BURNS RD STE 302
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4321
Practice Address - Country:US
Practice Address - Phone:561-622-7661
Practice Address - Fax:561-622-4651
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXEP10034290207Q00000X
WI62640-20207Q00000X
FLACN702208D00000X
FLME136965208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine