Provider Demographics
NPI:1891112843
Name:GODDANAKOPPAL RAJENDRA, SINDHU (MD)
Entity type:Individual
Prefix:
First Name:SINDHU
Middle Name:
Last Name:GODDANAKOPPAL RAJENDRA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14292 YALE STREET
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:248-982-6269
Mailing Address - Fax:
Practice Address - Street 1:2000 TRANSMOUNTAIN RD STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-3602
Practice Address - Country:US
Practice Address - Phone:915-215-8400
Practice Address - Fax:915-612-9254
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME160168207R00000X
GA077632207R00000X
TXU9931207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine