Basic Information
| Provider Information | |||||||||
| NPI: | 1124042007 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAO | ||||||||
| FirstName: | SUDEEP | ||||||||
| MiddleName: | NARAYANA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 SPRING HILL AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366041416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514351200 | ||||||||
| FaxNumber: | 2514356357 | ||||||||
| Practice Location | |||||||||
| Address1: | 831 HILLCREST RD STE C | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366954075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516334949 | ||||||||
| FaxNumber: | 2516334363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 07/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 24971 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 51536282 | 01 | AL | BCBS - FILLINGIM ST | OTHER | 009938447 | 05 | AL | MEDICAID | 51536200 | 01 | AL | BCBS - STANTON RD | OTHER | 01237334 | 05 | MS | MEDICAID | 009910919 | 05 | AL | MEDICAID | 009938446 | 05 | AL | MEDICAID | 51542496 | 01 | AL | BCBS - MEDICAL PARK FOUR | OTHER |