MEDICARE: BHARATH RADHAKRISHNA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME41076	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578550026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHARATH RADHAKRISHNA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-541-7500
Fax Number	:	239-541-7501

Provider Business Practice Location Address
First Line	:	2441 SURFSIDE BLVD STE 200
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-3861
Country	:	US
Telephone Number	:	239-541-7500
Fax Number	:	239-541-7501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	02/18/2026

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