Provider Demographics
NPI:1194751214
Name:RANGARAJ, GOPIKISHAN R (MD)
Entity type:Individual
Prefix:
First Name:GOPIKISHAN
Middle Name:R
Last Name:RANGARAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 W TIDWELL RD STE 316
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-4355
Mailing Address - Country:US
Mailing Address - Phone:713-742-8200
Mailing Address - Fax:713-742-8202
Practice Address - Street 1:509 W TIDWELL RD STE 316
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-4355
Practice Address - Country:US
Practice Address - Phone:713-742-8200
Practice Address - Fax:713-742-8202
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1633207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG32595Medicare UPIN
TX8F0175Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
TX258495YMSKMedicare PIN