Healthcare Provider Details

I. General information

NPI: 1376473421
Provider Name (Legal Business Name): MYATLAS PROVIDER GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2332 GALIANO ST FL 2
CORAL GABLES FL
33134-5402
US

IV. Provider business mailing address

2332 GALIANO ST FL 2
CORAL GABLES FL
33134-5402
US

V. Phone/Fax

Practice location:
  • Phone: 305-701-4286
  • Fax:
Mailing address:
  • Phone: 305-701-4286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIKRAM BAKHRU
Title or Position: PRESIDENT
Credential: MD
Phone: 305-701-4286