Individual
RAJAGOPALAN RAVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2632 N 20TH ST, PHOENIX, AZ 85006-1339
(602) 266-2200
(602) 240-5862
Mailing address
PO BOX 61773, PHOENIX, AZ 85082-1773
(602) 266-2200
(602) 240-6177
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
10584
AZ
2086S0129X
Vascular Surgery Physician
10584
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020046638
RAILROAD MEDICARE
AZ
05
—
220004
—
AZ
01
—
WCSKQ
SUN HEALTH GROUP #
AZ
Enumeration date
08/02/2005
Last updated
09/12/2012
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