Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 237486 | MA |
N | 111NI0900X | Internist | 237486 | MA |
N | 207R00000X | Internist | P1099 | TX |
N | 111NI0900X | Internist | P1099 | TX |
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | ME144310 | FL |
Y | 207RC0000X | Internist - Cardiovascular Disease | ME144310 | FL |
NPI | 1235378217 |
---|---|
Provider Name | Raghavendra Charan P Makam |
First Address | Vero Beach, FL 32966-3132 |
Second Address | Vero Beach, FL 32960-4862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2009 |
Last Update Date | 12/07/2021 |