Provider Demographics
NPI:1215172713
Name:PARADKAR, RUPALI ABHIJIT (MD)
Entity type:Individual
Prefix:
First Name:RUPALI
Middle Name:ABHIJIT
Last Name:PARADKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SE 13TH CT
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7857
Mailing Address - Country:US
Mailing Address - Phone:479-273-9056
Mailing Address - Fax:479-273-6937
Practice Address - Street 1:1000 SE 13TH CT
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7857
Practice Address - Country:US
Practice Address - Phone:479-273-9056
Practice Address - Fax:479-273-6937
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-10778207R00000X
MI4301097566208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I110921Medicare PIN
GAP00779971Medicare PIN
GA624742976AMedicaid