Provider Demographics
NPI:1841286937
Name:RAO, KATIKINENI V (MD)
Entity type:Individual
Prefix:DR
First Name:KATIKINENI
Middle Name:V
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2100 4TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-4518
Mailing Address - Country:US
Mailing Address - Phone:517-787-4332
Mailing Address - Fax:517-787-4861
Practice Address - Street 1:2100 4TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-4518
Practice Address - Country:US
Practice Address - Phone:517-787-4332
Practice Address - Fax:517-787-4861
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301031905208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1379549Medicaid
MI1379549Medicaid