Basic Information
| Provider Information | |||||||||
| NPI: | 1649241829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANGARAJ | ||||||||
| FirstName: | KUMUD | ||||||||
| MiddleName: | SHARMA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1505 NORTHSIDE BLVD STE 4600 | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300417658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702055292 | ||||||||
| FaxNumber: | 7702055291 | ||||||||
| Practice Location | |||||||||
| Address1: | 1505 NORTHSIDE BLVD STE 4600 | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300417658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702055292 | ||||||||
| FaxNumber: | 7702055291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 11/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | KS082798 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 059007 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0B56404008 | 01 | MI | BCR | OTHER | 4790701 | 05 | MI | MEDICAID |