Basic Information
| Provider Information | |||||||||
| NPI: | 1336171958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAJU | ||||||||
| FirstName: | BHUPATIRAJU | ||||||||
| MiddleName: | RAMA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14690 SPRING HILL DR | ||||||||
| Address2: | STE 305 | ||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346098102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522775348 | ||||||||
| FaxNumber: | 3526062857 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 DESOTO AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346012814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527966721 | ||||||||
| FaxNumber: | 3527540375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 11/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME0021368 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 189163 | 01 | FL | STAYWELL AND WELLCARE | OTHER | P11197684 | 01 | FL | MULTIPLAN | OTHER | 5473411 | 01 | FL | FIRST HEALTH | OTHER | 054390000 | 05 | FL | MEDICAID | P00013910 | 01 | FL | RAIL ROAD MEDICARE | OTHER | 201943 | 01 | FL | AV MED | OTHER | 26022 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | P00984625 | 01 | FL | RR MCR | OTHER | 1551518 | 01 | FL | GHI | OTHER | 008054600 | 05 | FL | MEDICAID | 4595765 | 01 | FL | AETNA | OTHER |