Provider Demographics
NPI:1841267796
Name:RAJAGOPALAN, KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:KUMAR
Middle Name:
Last Name:RAJAGOPALAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10006 ROSEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3938
Mailing Address - Country:US
Mailing Address - Phone:954-899-6739
Mailing Address - Fax:954-227-6690
Practice Address - Street 1:3505 NW 84TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6607
Practice Address - Country:US
Practice Address - Phone:954-906-0204
Practice Address - Fax:954-289-3902
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 50454207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045636500Medicaid
FLD20795Medicare UPIN
FL022860Medicare PIN