Provider Demographics
NPI:1366618209
Name:PRABAKARAN, RAJEEV (MD)
Entity type:Individual
Prefix:
First Name:RAJEEV
Middle Name:
Last Name:PRABAKARAN
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 9TH ST N STE 304
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5887
Mailing Address - Country:US
Mailing Address - Phone:239-624-2730
Mailing Address - Fax:239-624-2731
Practice Address - Street 1:311 9TH ST N STE 304
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5887
Practice Address - Country:US
Practice Address - Phone:239-624-2730
Practice Address - Fax:239-624-2731
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 118881207RG0100X
MA251052207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHW302ZOtherMEIDCARE
FL011809100Medicaid
FLK7665OtherMEDICARE GROUP
FL14UW9OtherBCBS
FL011809100Medicaid