Provider Demographics
NPI:1801859988
Name:UTTAMCHANDANI, RAJ B (MD)
Entity type:Individual
Prefix:
First Name:RAJ
Middle Name:B
Last Name:UTTAMCHANDANI
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 1:7000 SW 62ND AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4716
Mailing Address - Country:US
Mailing Address - Phone:305-740-6071
Mailing Address - Fax:305-740-9623
Practice Address - Street 1:7000 SW 62ND AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4716
Practice Address - Country:US
Practice Address - Phone:305-740-6071
Practice Address - Fax:305-740-9623
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046616207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047640400Medicaid
05681AMedicare ID - Type Unspecified
FL047640400Medicaid