Provider Demographics
NPI:1972698678
Name:RAJU, PADMA K (MD)
Entity type:Individual
Prefix:DR
First Name:PADMA
Middle Name:K
Last Name:RAJU
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 1:311 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4421
Mailing Address - Country:US
Mailing Address - Phone:407-933-1423
Mailing Address - Fax:407-933-7901
Practice Address - Street 1:311 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4421
Practice Address - Country:US
Practice Address - Phone:407-933-1423
Practice Address - Fax:407-933-7901
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065580207RC0000X
FLME65580207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97822Medicare ID - Type Unspecified
FL97822AMedicare PIN
FL23959XMedicare PIN
FLE85386Medicare UPIN