Healthcare Provider Details

I. General information

NPI: 1013977339
Provider Name (Legal Business Name): SANDEEP VIDYADHAR BHADKAMKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

IV. Provider business mailing address

6701 AIRPORT BLVD STE D143
MOBILE AL
36608-6701
US

V. Phone/Fax

Practice location:
  • Phone: 251-266-3580
  • Fax: 251-266-3581
Mailing address:
  • Phone: 251-342-3949
  • Fax: 251-266-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00025799
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: