Provider Demographics
NPI:1861944324
Name:RAJENDRAN PHYSICIAN GROUP,INC
Entity type:Organization
Organization Name:RAJENDRAN PHYSICIAN GROUP,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJENDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-752-1053
Mailing Address - Street 1:1507 W REYNOLDS ST
Mailing Address - Street 2:STE B
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4702
Mailing Address - Country:US
Mailing Address - Phone:813-752-1053
Mailing Address - Fax:
Practice Address - Street 1:1507 W REYNOLDS ST
Practice Address - Street 2:STE B
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4702
Practice Address - Country:US
Practice Address - Phone:813-752-1053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 11825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty