Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2009014213 | MO |
N | 111NI0900X | Internist | 2009014213 | MO |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | R2451 | TX |
NPI | 1043448285 |
---|---|
Provider Name | Dr. Praveen Kalipatnam Rao |
First Address | Dallas, TX 75226-1316 |
Second Address | Dallas, TX 75226-1316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 15/09/2017 |