Provider Demographics
NPI:1841251006
Name:KAKARLA, RAJENDRA (MD)
Entity type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:
Last Name:KAKARLA
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:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869-0028
Mailing Address - Country:US
Mailing Address - Phone:419-629-3663
Mailing Address - Fax:419-629-2783
Practice Address - Street 1:3920 SOUTHLAND RD
Practice Address - Street 2:
Practice Address - City:NEW BREMEN
Practice Address - State:OH
Practice Address - Zip Code:45869
Practice Address - Country:US
Practice Address - Phone:419-629-3663
Practice Address - Fax:419-629-2783
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062730207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0266135Medicaid
OH000000130575OtherANTHEM
OH060037363OtherRR MEDICARE
OH000000130575OtherANTHEM
OH0266135Medicaid