Provider Demographics
NPI:1205501996
Name:RAJESH BOORGU MD, LLC
Entity type:Organization
Organization Name:RAJESH BOORGU MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOORGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-766-1401
Mailing Address - Street 1:422 E DR HICKS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5730
Mailing Address - Country:US
Mailing Address - Phone:256-766-1401
Mailing Address - Fax:256-766-1402
Practice Address - Street 1:201 AVALON AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2805
Practice Address - Country:US
Practice Address - Phone:256-766-1401
Practice Address - Fax:256-766-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty