Provider Demographics
NPI:1992905095
Name:RAO, SANDEEP (MD, MBA)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:
Last Name:RAO
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29650
Mailing Address - Street 2:DEPT# 8800391
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038
Mailing Address - Country:US
Mailing Address - Phone:855-381-9178
Mailing Address - Fax:913-234-1116
Practice Address - Street 1:6036 N 19TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2104
Practice Address - Country:US
Practice Address - Phone:480-616-0356
Practice Address - Fax:480-616-0603
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-08232085R0202X, 2085R0204X
TXN66012085R0202X, 2085R0204X
AZ518722085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DG725OtherBCBS TX
TX8DG725OtherBCBS TX