Provider Demographics
NPI:1376700203
Name:SIDDABATTUNI, RANA (MD)
Entity type:Individual
Prefix:
First Name:RANA
Middle Name:
Last Name:SIDDABATTUNI
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 1:4692 NW 183RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-3054
Mailing Address - Country:US
Mailing Address - Phone:786-625-7774
Mailing Address - Fax:786-625-7714
Practice Address - Street 1:4692 NW 183RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-3054
Practice Address - Country:US
Practice Address - Phone:786-625-7774
Practice Address - Fax:786-625-7714
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME160125207R00000X
DCMD038908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC221315YBAUMedicare PIN